Multi-Impact System for Prosthesis Deployment Device

ABSTRACT

A deployment device for a prosthesis includes a driving assembly, including a driving tube and a driving pin. The driving assembly can impact a driven assembly, which is further connected to the prosthesis. The driving assembly can impact the driven assembly multiple times, thereby driving the prosthesis further into a tissue.

RELATED APPLICATIONS

This application is related to the following commonly owned co-pendingapplications: U.S. patent application Ser. No. ______, filed Jul. 18,2012, titled “Impact And Drive System For Prosthesis Deployment Device”;U.S. patent application Ser. No. ______, filed Jul. 18, 2012, titled“Detachable Front Delivery Assembly For A Tissue Repair System”; U.S.patent application Ser. No. ______, filed Jul. 18, 2012, titled “AnExpandable Prosthesis For A Tissue Repair System”; and U.S. patentapplication Ser. No. ______, filed Jul. 18, 2012, titled “Method AndSystem For Implanting Multiple Prostheses”, which are all hereinincorporated by reference.

BACKGROUND

The present embodiments relate generally to systems and methods forrepairing tissue.

Sutures are often used to repair various imperfections in tissue. Forexample, flaws, holes, tears, bulges, a deliberate cut or incision mayall be repaired using sutures. In the case of a rotator cuff tendontear, sutures may be used to help re-attach the torn or receded portionof the rotator cuff tendon to the humerus bone. Sutures are also used torepair glenoid labrum tears and superior labrum anterior and posterior(SLAP) tears.

SUMMARY

In one aspect, a deployment device for a prosthesis includes a drivenassembly configured to apply a force to the prosthesis. The drivenassembly includes a driven tube including a hollow longitudinal cavityand the driven assembly also includes a driven pin. The deploymentdevice also includes a driving assembly configured to drive the drivenpin and the driven tube. The driven pin can move through the hollowlongitudinal cavity of the driven tube.

In another aspect, a deployment device for a prosthesis includes adriven assembly configured to apply a force to the prosthesis. Thedriven assembly includes a driven tube including a hollow longitudinalcavity and the driven assembly also includes a driven pin. The drivenpin is configured to move through the hollow longitudinal cavity of thedriven tube. The driven tube is configured to move a first distance andthe driven pin is configured to move a second distance. The firstdistance is substantially greater than the second distance.

In another aspect, a deployment device for a prosthesis includes adriving assembly comprising a driving pin and a driving tube. Thedriving tube includes a first hollow longitudinal cavity, where thedriving pin can move through the first hollow longitudinal cavity. Thedeployment device also includes a driven assembly to apply a force tothe prosthesis, where the driven assembly also includes a driven tubeincluding a second hollow longitudinal cavity and where the drivenassembly also includes a driven pin. The driven pin is configured tomove through the second hollow longitudinal cavity of the driven tubeand the driving tube, the driving pin, the driven tube, and the drivenpin are all aligned along a longitudinal axis.

In another aspect, a kit of parts for tissue repair includes a firstfront delivery assembly including at least one prosthesis configured forimplantation and a second front delivery assembly including at least oneprosthesis configured for implantation. The kit of parts also includes abase assembly, where the first front delivery assembly can be removablyattached to the base assembly and where the second front deliveryassembly can be removably attached to the base assembly. The baseassembly is configured to provide power assistance for implantingprostheses.

In another aspect, a deployment device for tissue repair includes afirst prosthesis and a second prosthesis. The deployment device alsoincludes a driving assembly configured to provide a driving force. Thefirst prosthesis and the second prosthesis can be positioned within thedeployment device at a first configuration and a second configuration.The first prosthesis is aligned with the driving assembly in the firstconfiguration and the second prosthesis is out of alignment with thedriving assembly in the first configuration. The second prosthesis isaligned with the driving assembly in the second configuration and thefirst prosthesis is out of alignment with the driving assembly in thesecond configuration.

In another aspect, a method of operating a deployment device for tissuerepair includes attaching a front delivery assembly including at leastone prosthesis to a base assembly. The method also includes aligning thefront delivery assembly with a desired region of tissue. The method alsoincludes implanting the at least one prosthesis using the deploymentdevice and detaching the front delivery assembly from the base assembly.

In another aspect, a prosthesis configured for implantation into tissueincludes a driving portion including a driving tip portion and a wedgeportion as well as a base portion including a forward portion and arearward portion, where the forward portion being associated with thedriving portion. The base portion includes a first longitudinal portionthat extends along the length of the base portion and a secondlongitudinal portion that extends along the length of the base portion.The first longitudinal portion and the second longitudinal portion areattached at the rearward portion, and the first longitudinal portion andthe second longitudinal portion are separable at the forward portion.The first longitudinal portion is associated with a first surface of thewedge portion, and the second longitudinal portion is associated with asecond surface of the wedge portion. The first longitudinal portion andthe second longitudinal portion are configured to engage the wedgeportion and spread apart from one another during the implantation of theprosthesis.

In another aspect, a prosthesis for tissue repair includes a drivingportion including a driving tip portion and a wedge portion and a baseportion including a forward portion and a rearward portion, where theforward portion is disposed adjacent to the wedge portion. The baseportion is configured to expand when the forward portion is engaged bythe wedge portion. The forward portion is connected to the wedge portionprior to implantation into a tissue and the forward portion and thewedge portion are configured to separate during an implantation process.

In another aspect, a prosthesis configured for implantation into tissueincludes a driving portion and a base portion including a forwardportion and a rearward portion, where the forward portion beingassociated with the driving portion. The prosthesis also includes awedge portion associated with the rearward portion of the base portion.The base portion includes a first longitudinal portion that extendsalong the length of the base portion and a second longitudinal portionthat extends along the length of the base portion. The firstlongitudinal portion and the second longitudinal portion are attached atthe forward portion and the first longitudinal portion and the secondlongitudinal portion are separable at the rearward portion. The firstlongitudinal portion and the second longitudinal portion are configuredto engage the wedge portion and spread apart from one another during theimplantation of the prosthesis.

In another aspect, a prosthesis for tissue repair includes a drivingportion. The prosthesis also includes a base portion including a forwardportion and a rearward portion, where the forward portion is associatedwith the driving portion. The prosthesis also includes a wedge portionassociated with the rearward portion of the base portion. The baseportion is configured to expand when the rearward portion is engaged bythe wedge portion. The rearward portion is connected to the wedgeportion prior to implantation into a tissue and the rearward portion andthe wedge portion are configured to separate during an implantationprocess.

In one aspect, a tissue repair system includes a deployment deviceconfigured to house two or more prostheses, where the deployment deviceprovides two prosthesis positions including a driving position and astorage position. The tissue repair system also includes a firstprosthesis, a second prosthesis, and at least one connecting member. Thedeployment device has an initial configuration where the firstprosthesis is in the driving position, the second prosthesis is in thestorage position, and the at least one connecting member joins the firstprosthesis and the second prosthesis. The deployment device isconfigured to implant the first prosthesis and the second prosthesis inmultiple stages. A first stage includes the first prosthesis beingimplanted from the driving position such that the at least oneconnecting member extends from the implanted first prosthesis to thesecond prosthesis in the storage position. A second stage includes thesecond prosthesis being moved from the storage position to the drivingposition. And a third stage includes the second prosthesis beingimplanted from the driving position with the connecting member stilljoining the first prosthesis and the second prosthesis.

In another aspect, a tissue repair system includes a deployment deviceconfigured to house two or more prostheses, where the deployment deviceprovides two prosthesis positions including a driving position and astorage position. The tissue repair system also includes a plurality ofprostheses and at least one connecting member. The deployment device hasan initial configuration in which one of the plurality of prostheses isin the driving position, one or more other prostheses of the pluralityof prostheses is in the storage position, and the connecting memberjoins together each prosthesis of the plurality of prostheses. Thedeployment device is configured to implant each prosthesis of theplurality of prostheses in multiple stages. The multiple stages includea stage of implanting the one prosthesis from the driving position. Themultiple stages also include a stage of moving at least one of the oneor more other prostheses from the storage position to the drivingposition.

In another aspect, a method of implanting multiple prostheses into atissue using a deployment device includes aligning an end of thedeployment device in a first location, where the deployment deviceincludes an energy storage system that provides power to implantprostheses. The method also includes releasing energy of the energystorage system such that the deployment device implants a firstprosthesis in the first location, where the implanted first prosthesisis attached by at least one connecting member to a second prosthesisinside the deployment device. The method also includes adjusting theposition of the second prosthesis within the deployment device so thatthe second prosthesis is configured for implantation. The method alsoincludes aligning the end of the deployment device in a second locationthat is different from the first location. The method also includesreleasing energy of the energy storage system such that the deploymentdevice implants the second prosthesis in the second location, where thefirst prosthesis and the second prosthesis are joined by the at leastone connecting member extending from the first location to the secondlocation.

In one aspect, a deployment device for repairing tissue includes a frontdelivery assembly including a driven assembly configured to hold aprosthesis, a base assembly including a driving assembly that isconfigured to impact the driven assembly and a trigger assembly foractivating the driving assembly. The deployment device is configuredsuch that the driving assembly is adapted to impact the driven assemblymultiple times by engaging the trigger assembly multiple times.Subsequent impacts of the driving assembly with the driven assembly areconfigured to drive the prosthesis farther into the tissue.

In another aspect, a deployment device includes a front deliveryassembly including a driven assembly configured to hold a prosthesis, abase assembly including a driving assembly, and a trigger assembly foractivating the driving assembly. The deployment device is operable in aninitial state in which the driving assembly is at rest and the drivingassembly and the driven assembly are spaced apart by a first distance.The deployment device is also operable in an intermediate state in whichthe driving assembly is at rest and the driving assembly and the drivenassembly are spaced apart by a second distance. The deployment device isalso operable in a final state in which the driving assembly is at restand the driving assembly and the driven assembly are spaced apart by athird distance. The third distance is greater than the second distanceand wherein the second distance is greater than the first distance.

In another aspect, a method of implanting a prosthesis into tissue usinga deployment device includes actuating a driving assembly so that thedriving assembly engages a driven assembly corresponding to theprosthesis, observing a position of a depth indicator that is associatedwith a depth to which the prosthesis has been implanted within thetissue, and actuating the driving assembly a second time if the positionof the depth indicator is spaced apart from a predetermined depthposition.

Other systems, methods, features and advantages of the embodiments willbe, or will become, apparent to one of ordinary skill in the art uponexamination of the following figures and detailed description. It isintended that all such additional systems, methods, features andadvantages be included within this description and this summary, bewithin the scope of the embodiments, and be protected by the followingclaims.

BRIEF DESCRIPTION OF THE DRAWINGS

The embodiments can be better understood with reference to the followingdrawings and description. The components in the figures are notnecessarily to scale, emphasis instead being placed upon illustratingthe principles of the embodiments. Moreover, in the figures, likereference numerals designate corresponding parts throughout thedifferent views.

FIG. 1 is a schematic diagram of an example of a shoulder jointincluding the attachment of rotator cuff tendons to the greatertuberosity of the humerus;

FIG. 2 is a schematic diagram of an example of a shoulder joint in whicha rotator cuff tendon has partially torn;

FIG. 3 is a schematic diagram of a conventional method of repairing atorn rotator cuff tendon;

FIG. 4 is a schematic diagram that shows a surgeon preparing to repair atorn rotator cuff tendon according to one embodiment;

FIG. 5 is a schematic diagram of an embodiment of a deployment device aswell as various components of the deployment device;

FIG. 6 is a schematic diagram that shows a surgeon using a deploymentdevice to install a first prosthesis according to one embodiment;

FIG. 7 is a schematic diagram that shows a surgeon adjusting adeployment device to align a second prosthesis with a driving deviceaccording to one embodiment;

FIG. 8 is a schematic diagram that shows a surgeon using a deploymentdevice to install a second prosthesis according to one embodiment;

FIG. 9 is a schematic diagram of another embodiment of a portion of adeployment device that is configured to house three prostheses;

FIG. 10 is a schematic diagram of another embodiment of a portion of adeployment device that is configured to house five prostheses;

FIG. 11 is a schematic diagram of another embodiment of a portion of adeployment device that is configured to house any desired number ofprostheses;

FIG. 12 is a schematic diagram of an embodiment of a plurality ofprostheses being used to repair a portion of a rotator cuff tendon;

FIG. 13 is a schematic diagram illustrating an isometric view of anembodiment of a tissue repair system;

FIG. 14 is a schematic diagram illustrating an isometric exploded viewof an embodiment of a tissue repair system that includes a baseassembly, a front delivery assembly and a plurality of prostheses;

FIG. 15 is a schematic diagram illustrating an isometric cut-away viewof an embodiment of a tissue repair system that illustrates variousinternal components of a deployment device;

FIG. 16 is a schematic diagram illustrating an enlarged cut-away view ofan embodiment of a plurality of prostheses positioned within the end ofa front delivery assembly;

FIG. 17 is a schematic diagram illustrating an isometric view of anembodiment of a prosthesis;

FIG. 18 is a schematic diagram illustrating another isometric view ofthe prosthesis of FIG. 17, in which the prosthesis has been rotatedabout a central axis;

FIG. 19 a schematic diagram illustrating a schematic view of aprosthesis being aligned with a tissue according to one embodiment;

FIG. 20 is a schematic diagram illustrating another schematic view ofthe prosthesis of FIG. 19, in which the prosthesis has been driven intothe tissue;

FIG. 21 is a schematic diagram illustrating another schematic view ofthe prosthesis of FIG. 19, in which a base portion of the prosthesis hasstarted to expand;

FIG. 22 is a schematic diagram illustrating another schematic view ofthe prosthesis of FIG. 21, in which the base portion continues toexpand;

FIG. 23 is a schematic diagram illustrating another schematic view ofthe prosthesis of FIG. 22, in which the base portion is fully expanded;

FIG. 24 is a schematic diagram illustrating an isometric view of anotherembodiment of a prosthesis;

FIG. 25 is a schematic diagram illustrating a schematic view of aprosthesis being aligned with a tissue according to one embodiment;

FIG. 26 is a schematic diagram illustrating another schematic view ofthe prosthesis of FIG. 25, in which the prosthesis has been driven intothe tissue;

FIG. 27 is a schematic diagram illustrating another schematic view ofthe prosthesis of FIG. 26, in which a base portion of the prosthesis hasstarted to expand;

FIG. 28 is a schematic diagram illustrating another schematic view ofthe prosthesis of FIG. 26, in which the base portion continues toexpand;

FIG. 29 is a schematic diagram illustrating an isometric view of anembodiment of a prosthesis including three separated portions as well asan enlarged cut-away view of the prosthesis;

FIG. 30 is a schematic diagram illustrating a side view of an embodimentof the prosthesis of FIG. 29 split into three portions;

FIG. 31 is a schematic diagram of two different configurations for aprosthesis according to various embodiments;

FIG. 32 is a schematic diagram illustrating an isometric cut-away viewof portions of a front delivery assembly according to an embodiment;

FIG. 33 is a schematic diagram illustrating an isometric cut-away viewof an embodiment of a portion of a deployment device including views ofcomponents internal to a base assembly;

FIG. 34 is a schematic diagram illustrating an isometric cut away viewof a portion of a deployment device including a brace member;

FIG. 35 is a schematic diagram illustrating an isometric view of anembodiment of the coaxial alignment of several components of a tissuerepair system;

FIG. 36 is a schematic diagram illustrating a side view of somecomponents of a deployment device being aligned with a tissue accordingto one embodiment;

FIG. 37 is a schematic diagram illustrating a side view of thecomponents of FIG. 36, in which a prosthesis is driven into the tissue;

FIG. 38 is a schematic diagram illustrating a side view of thecomponents of FIG. 37, in which a portion of the prosthesis begins toexpand;

FIG. 39 is a schematic diagram illustrating a side view of thecomponents of FIG. 38, in which a portion of the prosthesis continues toexpand;

FIG. 40 is a schematic diagram illustrating a side view of thecomponents of FIG. 39, in which the prosthesis has been fully implantedinto the tissue;

FIG. 41 is a schematic diagram illustrating a side cross-sectional viewof a portion of a deployment device according to one embodiment;

FIG. 42 is a schematic diagram illustrating a side cross-sectional viewof a portion of a deployment device according to one embodiment;

FIG. 43 is a schematic diagram illustrating an isometric cut-away viewof an embodiment of a portion of a base assembly including componentsused to generate and control an impact force;

FIG. 44 is a schematic diagram illustrating an isometric cut-away viewof the base assembly of FIG. 43, in which a control knob has beenadjusted;

FIG. 45 is an isometric cut-away view of the base assembly of FIG. 43,in which an impact spring has been loaded;

FIG. 46 is a schematic diagram illustrating an isometric cut-away viewof the base assembly of FIG. 43, in which an impact spring has beenreleased and a driving pin and driving tube move together;

FIG. 47 is a schematic diagram illustrating an isometric cut-away viewof the base assembly of FIG. 43, in which a control hook releases aprojecting portion of the driving pin;

FIG. 48 is a schematic diagram illustrating an isometric cut-away viewof the base assembly of FIG. 43, in which a driving pin and a drivingtube can move independently;

FIG. 49 is a schematic diagram illustrating an embodiment of a baseassembly including a trigger assembly;

FIG. 50 is a schematic diagram of the base assembly of FIG. 49, in whichthe trigger assembly is engaged;

FIG. 51 is a schematic diagram of the base assembly of FIG. 49, in whichthe trigger assembly is engaged and an impact spring has been released;

FIG. 52 is a schematic diagram of the base assembly of FIG. 49, in whichthe trigger assembly and a driving assembly are returning to a defaultposition;

FIG. 53 is a schematic diagram illustrating an isometric cut-away viewof an embodiment of a portion of a front delivery assembly and a portionof a base assembly;

FIG. 54 is a schematic diagram illustrating an isometric view of aportion of a front delivery assembly, which includes a rotatingassembly;

FIG. 55 is a schematic diagram illustrating an isometric cut-away viewof a portion of a deployment device according to one embodiment;

FIG. 56 is a schematic diagram illustrating a detailed side view of anembodiment of a deployment device in a pre-deployment state;

FIG. 57 is a schematic diagram of the deployment device of FIG. 56, inwhich the prosthesis is being driven into a tissue;

FIG. 58 is a schematic diagram of the deployment device of FIG. 57, inwhich the prosthesis has been partially implanted into the tissue;

FIG. 59 is a schematic diagram of the deployment device of FIG. 58, inwhich the prosthesis is being driven further into the tissue;

FIG. 60 is a schematic diagram of the deployment device of FIG. 59, inwhich the prosthesis is fully driven into the tissue;

FIG. 61 is a schematic diagram illustrating a schematic view of a methodof implanting multiple prostheses according to one embodiment;

FIG. 62 is a schematic diagram illustrating another view of the methodof FIG. 61, in which a rotating assembly has been rotated by 90 degrees;

FIG. 63 is a schematic diagram illustrating another view of the methodof FIG. 61, in which a rotating assembly has been rotated by 180degrees;

FIG. 64 is a schematic cut-away diagram of a portion of a front deliveryassembly, in which the top half of the front delivery assembly has beenremoved forwards of a locking ring, and which further illustrates thelocking ring in a ready to actuate position according to an embodiment;

FIG. 65 is a schematic cut-away diagram illustrating the locking ring ofFIG. 64 in a locked out position according to an embodiment;

FIG. 66 is a schematic diagram illustrating an isometric cut-away viewof a portion of a deployment device according to one embodiment, inwhich a front delivery assembly is attached to a base assembly;

FIG. 67 is a schematic diagram illustrating the location where a surgeonmay apply a force to remove a front delivery assembly from a baseassembly according to one embodiment;

FIG. 68 is a schematic diagram illustrating an isometric cut-away viewof a portion of the deployment device of FIG. 66 as a front deliveryassembly has started to disengage from a base assembly;

FIG. 69 is a schematic diagram illustrating an isometric cut-away viewof a portion of the deployment device of FIG. 66 as a front deliveryassembly has been fully disengaged from a base assembly;

FIG. 70 is a schematic diagram illustrating a schematic view of anembodiment of a kit of parts including a base assembly and a pluralityof front delivery assemblies;

FIG. 71 is a schematic diagram illustrating an isometric view of anembodiment of a front delivery assembly including a plurality of holdingmembers;

FIG. 72 is a schematic diagram illustrating a possible use for holdingmembers of a front delivery assembly according to one embodiment; and

FIG. 73 is a schematic diagram illustrating an isometric view of anembodiment of a front delivery assembly in which a plurality of holdingmembers may be hidden within a retractable cannula of the front deliveryassembly.

DETAILED DESCRIPTION

FIG. 1 illustrates a schematic view of an embodiment of some elements ofshoulder joint 100. More generally, shoulder joint 100 may comprise aball and socket joint formed by the humerus and scapula bones. Shoulderjoint 100 may generally comprise various muscles and tendons that helpwith stabilization of the joint. For example, shoulder joint 100 mayinclude four muscles including the supraspinatus muscle, theinfraspinatus muscle, the teres minor muscle and the subscapularismuscle. These muscles may be attached to the greater tuberosity 104 andlesser tuberosity 103 of humerus 102 by various groups of tendons. Thefusion of the tendons associated with each of the muscle groups formsthe rotator cuff. As one example, subscapularis tendon 106, alsoreferred to simply as tendon 106, provides attachment of thesubscapularis muscles to lesser tuberosity 103 of humerus 102.Additionally, the current embodiment also clearly illustratessupraspinatus tendon 107, which attaches the supraspinatus muscles togreater tuberosity 104 of humerus 102.

At times, a tendon of the rotator cuff, such as tendon 106 may beruptured or torn, a condition commonly referred to as a “torn rotatorcuff.” Rotator cuff tears may be classified as partial thickness tearsor full thickness tears, as well as by whether the tendon has completelydetached from the greater tuberosity 104 or lesser tuberosity 103 ofhumerus 102. By way of example, FIG. 2 illustrates a schematic view ofan embodiment of shoulder joint 100 in which tendon 106 has been torn.In particular, tear 120 is a partial tear that occurs adjacent to theregion where tendon 106 attaches to humerus 102.

Although FIG. 2 illustrates one possible location for a rotator cufftear, it will be understood that tears can occur at any location alongtendon 106. Other examples of tears include glenoid labrum tears andSLAP (superior labrum anterior and posterior) tears. It will beunderstood that this is not intended to be an exhaustive list ofpossible tears. The method and system discussed below for repairingtears is not limited to tears of the kind illustrated in FIG. 2.Instead, FIG. 2 is meant to illustrate one possible example of a tearfor purposes of clarifying the general method and system for repairdisclosed throughout the remainder of this detailed description. Asdiscussed in further detail below, the method and system discussed inthese embodiments may be utilized for repairing a wide variety of tearsor other imperfections in various different kinds of tissues.

FIG. 3 is intended to illustrate a schematic view of one possible methodof repairing a rotator cuff tear 123, in which an end portion of tendon106 has been fully detached from humerus 102. The method illustrated inFIG. 3 for repairing rotator cuff tears may be complex and may requiremany steps that could be difficult to perform by surgeons. In somecases, one step of the repair surgery involves passing sutures 132through tendon 106 to form a predetermined stitch. These stitches can becomplicated to ensure the end of the tendon is properly anchored. Inanother step, the surgeon may form bone tunnels 130 in humerus 102,typically through the use of a cortical gauge punch or similar tool (notshown). As many bone tunnels are necessary, the cortical gauge punch maybe used many times in succession. With the stitches made in tendon 106and bone tunnels 130 formed in humerus 102, sutures 132 must then bethreaded through bone tunnels 130. This may be achieved using a plunger134 or similar tool. Finally, once all sutures 132 have been passedthrough bone tunnels 130, the ends of sutures 132 must be matched withcorresponding ends and tied together with knots (not shown). Thisprocess may be time consuming and laborious due to the large number ofsteps. Moreover, the complexity of the process may limit the number ofsurgeons able to perform the operation. Other methods for repairing atear in a tendon may use anchors. These other methods may also requiresutures to be tied together during surgery (following implantation ofanchors into the bone), which can be a time consuming and laboriousprocess.

System and Method for Implanting Multiple Prostheses

In contrast to the embodiment shown in FIG. 3, FIGS. 4 through 73 aredirected towards embodiments of a system and method that simplifies therepair of a rotator cuff tendon by limiting the complexity of the repairas well as the number of steps involved. The system and method describedbelow may be generally characterized by a plurality of prostheses and anassociated deployment device for implanting the plurality of prostheses.In some embodiments, the plurality of prostheses could be physicallyattached through some joining mechanism, or simply intended for usetogether. In some cases, for example, a plurality of prostheses maycomprise a plurality of suturing anchors that are joined using one ormore suture threads. However, in other embodiments, a plurality ofprostheses could comprise other kinds of prostheses known in the art.Moreover, the term “prosthesis” as used throughout this detaileddescription and in the claims refers to any device, component, or otherelement that is configured to be implanted into a portion of the body.It will be understood that the term prosthesis is not intended todesignate a particular structure, material, location, or function.

FIG. 4 illustrates a schematic view of patient 140 undergoing rotatorcuff repair surgery. Specifically, surgeon 142 may perform a surgicalprocedure that attempts to repair tear 120 of tendon 106. Surgeon 142may be provided with tissue repair system 148 according to oneembodiment. In some embodiments, tissue repair system 148 may compriseplurality of prostheses 160 (see FIG. 5) that may be implanted intotendon 106 and/or humerus 102 in order to repair tear 120. In someembodiments, tissue repair system 148 may also comprise deploymentdevice 150, which is used to implant plurality of prostheses 160 at thelocation of tear 120.

For purposes of clarity, patient 140 is shown with a single incision 144through which deployment device 150 may be inserted to facilitate theimplantation of one or more prostheses. However, in some cases,additional incisions may be made at the shoulder to facilitate the useof other instrumentation. For example, an arthroscope may be insertedinto a second incision simultaneously with the insertion of deploymentdevice 150 into incision 144. This may allow surgeon 142 to inspect tear120 carefully and may also be used to guide the implantation of one ormore prostheses using deployment device 150. Moreover, it will also beunderstood that in other situations, tissue repair system 148 could beused in conjunction with any other surgical technique including opensurgery, in which the shoulder joint may be fully exposed duringimplantation.

Although the following embodiments describe the use of tissue repairsystem 148 for repairing tears in a rotator cuff tendon, theapplications of tissue repair system 148 are not limited to thisparticular use. Instead, this particular application simply highlightshow one type of tissue repair may be improved through the use of tissuerepair system 148. Moreover, this method could be utilized in repairinga wide range of imperfections or irregularities in tissue including, butnot limited to: flaws, holes, tears, bulges, a deliberate cut orincision, as well as any other imperfections.

FIG. 5 illustrates a schematic view of one possible embodiment of tissuerepair system 148. For purposes of clarity, deployment device 150,plurality of prostheses 160, and their corresponding sub-components areshown schematically in FIGS. 5 through 13. Referring to FIG. 5, eachprosthesis of plurality of prostheses 160 may be joined by connectingmember 166 while housed within deployment device 150. In someembodiments, connecting member 166 may be a suture thread. However, inother embodiments, connecting member 166 could comprise a more rigidmember. In another embodiment, for example, connecting member 166 couldcomprise a plastic connecting member that is substantially stiffer thana suture thread. In still other embodiments, the structural propertiesof connecting member 166 may vary in any manner and may generally bedetermined according to the type of repair needed. For example, insituations where tissue repair system 148 may be used to fastendifferent portions of bone together, a connecting member that issubstantially more rigid than suture thread may be used to help fastenthe portions of bone together. Still other examples of connectingmembers include, but are not limited to nets and meshes.

In one embodiment, plurality of prostheses 160 includes first prosthesis162 and second prosthesis 164. In some embodiments, first prosthesis 162and/or second prosthesis 164 may comprise anchors that are intended forimplantation into one or more kinds of tissue. This configuration mayallow first prosthesis 162 and second prosthesis 164 to act as anchorsfor connecting member 166, which may comprise a suture thread aspreviously discussed.

In different embodiments, the general form or structure of deploymentdevice 150 may vary. In one embodiment, for example, housing 152 ofdeployment device 150 may take the form of a handheld device. In somecases, housing 152 may include a handgrip portion 170. This generalshape allows deployment device 150 to be easily handled and used.Although the current embodiment illustrates a generic shape for handgripportion 170, other embodiments could include additional provisions toenhance handling and use. For example, some embodiments couldincorporate contours that conform to the natural shape and position offingers along handgrip portion 170. Still other embodiments could usepads or similar provisions to enhance grip and/or cushioning.

In some embodiments, deployment device 150 may be configured totemporarily house plurality of prostheses 160 up until the time ofimplantation. In some cases, therefore, housing 152 may include deliveryportion 172 that extends away from handgrip portion 170. With handgripportion 170 held by the surgeon, delivery portion 172 may be configuredto insert through an incision or other opening in order to alignplurality of prostheses 160 with the desired region of tissue. In somecases, therefore, delivery portion 172 may be configured with a narrowtube-like, or barrel, shape. This shape for delivery portion 172 mayhelp to reduce the footprint of deployment device 150 at the intendedimplantation site in order to improve precision of the deployment. Instill other embodiments, delivery portion 172 could be configured withany other geometry. Other suitable geometries for a delivery portion maybe selected according to various factors including the type of incision,the number, and/or arrangement of prostheses as well as other factors.

Deployment device 150 may include provisions for assisting a surgeonwith implanting plurality of prostheses 160 into tissue. In some cases,deployment device 150 may include actuating system 153. Generally,actuating system 153 could utilize any kind of actuators known in theart. In some cases, actuating system 153 may include an energy storagesystem 155. In some cases, actuating system 153 may further includedriving system 159. Using power generated by energy storage system 155,driving system 159 may generally apply the necessary impact and drivingforces to implant first prosthesis 162 and/or second prosthesis 164.

As one possible example, actuating system 153 is depicted schematicallyin FIG. 5 as comprising spring 154 and driving rod 156, which may beparticular components of energy storage system 155 and driving system159, respectively. As spring 154 expands, the mechanical energy storedwithin spring 154 generates the linear motion of driving rod 156, whichfurther acts to deploy one or more of plurality of prostheses 160 fromdeployment device 150. Other embodiments could use any other kind ofenergy storage systems for generating the required force to implantplurality of prostheses 160 into tissue. In another embodiment, forexample, energy storage system 155 could comprise a chemical energystorage system, such as a battery. Still other embodiments could usehydraulic energy, pneumatic energy, and/or electrical energy to generatethe necessary impact and driving forces for implanting prostheses. Instill another embodiment, combustion could be used to generate power forimplanting prostheses. It should be understood that deployment device150 could include additional provisions for charging, or otherwisesupplying sources of stored energy, for energy storage system 155. Forexample, in embodiments where energy storage system 155 includes abattery, deployment device 150 could include provisions for rechargingand/or interchanging a battery. As another example, in embodiments whereenergy storage system 155 uses combustion to actuate driving system 159,deployment device 150 could include provisions for replacing the sourceof the combustion energy (such as an explosive powder).

For purposes of clarity, driving system 159 is illustrated schematicallyas comprising a single driving rod 156 that acts to propel plurality ofprostheses 160 into a tissue. In other embodiments, driving system 159could comprise multiple components. For example, some embodiments couldincorporate one or more driven rods that mediate the transfer of forcesbetween a driving rod and a prosthesis. Still other cases may includemultiple driving components and multiple driven components. For example,one embodiment described in detail below includes a driving assemblywith a driving pin and a driving tube that houses the driving pin. Thedriving pin and driving tube may further interact with one or moredriven assemblies, where each driven assembly includes a driven pin anda corresponding driven tube.

In some embodiments, driving system 159 may be designed to facilitatethe implantation of plurality of prostheses 160 in a preciselycontrolled manner. For example, driving system 159 may be designed todeliver a predetermined amount of force to plurality of prostheses 160.Additionally, in some embodiments, driving system 159 may be designed tovary the location at which force is applied to plurality of prostheses160. In some embodiments, driving system 159 may also be designed todeliver force to plurality of prostheses 160 in multiple stages, ratherthan at a single instance. It will therefore be understood that otherembodiments of driving system 159 could incorporate any other componentsor systems that facilitate increased control over the implantationprocess.

Deployment device 150 can also include provisions that allow a user(such as a surgeon) to activate actuating system 153. In some cases,deployment device 150 may include user activation device 158. In FIG. 5,user activation device 158 is shown schematically as a trigger. In otherembodiments, deployment device 150 could include other kinds ofactivation devices, including, but not limited to: mechanical pushbuttons, electronic buttons, knobs, dials, and switches, as well as anyother activation devices known in the art. Moreover, some embodimentscould include various devices for modifying the operating properties ofactuating system 153. For example, some embodiments could include acontrol knob or dial for varying the magnitude of the impact forcegenerated by actuating system 153. An example of such a control knob isdescribed below.

Using the configuration described here, deployment device 150 may becapable of providing assistance to a surgeon when implanting one or moreprostheses. In particular, energy storage system 155, which can includecomponents such as spring 154, may provide assistance in generating theamount of force required to insert a prosthesis into various kinds oftissue, including bone. This power assistance can greatly increase easeof use over systems that may require the surgeon to generate an impactforce directly. Furthermore, the force generated by an energy storagesystem such as a spring may facilitate a more controlled impact anddriving motion for driving system 159 in comparison to systems that mayuse mechanical energy generated directly by a surgeon.

It will be understood that in some embodiments user activation device158 may be used to both store energy in energy storage system 155 andrelease energy from energy storage system 155. For example, in someembodiments user activation device 158 may be a trigger that is used toload spring 154 and to release spring 154. In some cases, both loadingand releasing of spring 154 may occur as a surgeon fully squeezes useractivation device 158. In other cases, however, user activation device158 may only be used to release energy from energy storage system 155.In such cases, deployment device 150 could incorporate additionalprovisions for loading spring 154.

Some embodiments of deployment device 150 can also include provisionsfor implanting multiple prostheses in a sequential manner. In someembodiments, deployment device 150 includes provisions for aligningmultiple prostheses with driving rod 156 in a sequential manner. In oneembodiment, this may be accomplished through the use of rotating portion157. In some cases, rotating portion 157 comprises a portion of deliveryportion 172 that is configured to rotate the positions of plurality ofprostheses 160. In one embodiment, rotating portion 157 may be rotatedto align driving rod 156 with different prostheses.

For consistency and convenience, reference is made to a forward-most endof a deployment device and a rearward-most end of a deployment device.The forward-most end of a deployment device may be the end where aprosthesis is configured to exit the deployment device. Therearward-most end may be the opposing end of the deployment device. Ingeneral use, the forward-most end may be disposed farthest from asurgeon, while the rearward-most end may be disposed closest to thesurgeon. Moreover, the terms “forward end” or “forward end portion” maydescribe portions of a component that are closer to the forward-most endof a deployment device. Likewise, the terms “rearward end” or “rearwardend portion” may describe portions of a component that are closer to therearward-most end of a deployment device.

FIGS. 6 through 8 illustrate views of a process for repairing a rotatorcuff tendon using tissue repair system 148 (see FIG. 5) according to oneembodiment. More specifically, each figure illustrates one possiblestep, or set of steps, in the process. As seen in FIG. 6, surgeon 142may insert delivery portion 172 of deployment device 150 into incision144. Generally, surgeon 142 may attempt to align forward end 174 ofdelivery portion 172 at a first location associated with tear 120. Insome cases, as discussed above, surgeon 142 may use an arthroscope orsimilar device to guide forward end 174 to the first location of tear120. In addition, in some cases, deployment device 150 may includeprovisions that allow surgeon 142 to manipulate one or more portions oftendon 106. For example, deployment device 150 could include provisionsfor grasping tendon 106 on either side (or both sides) of tear 120. Someembodiments, for example, could include pin-like members that projectoutwardly from forward end 174 and help to hold down the tendon duringimplantation. An example of such an embodiment is described in detailbelow and shown in FIGS. 71 through 73.

As represented by arrow 199, as surgeon 142 squeezes user activationdevice 158, actuating system 153 is activated and applies a drivingforce to first prosthesis 162. As user activation device 158 isdepressed, energy may be released from energy storage system 155 (seeFIG. 5). In particular, spring 154 is released from a compressed stateand expands rapidly, which acts to propel driving rod 156 and firstprosthesis 162. In FIG. 6, arrow 197 represents the motion of drivingrod 156 and first prosthesis 162 as spring 154 expands. First prosthesis162 is then driven through tendon 106 and into greater tuberosity 104 ofhumerus 102. Thus, the implantation of first prosthesis 162 facilitatesthe joining of the opposing edges of tear 120 of tendon 106. Onceimplanted into humerus 102, first prosthesis 162 serves as an anchor forone end of connecting member 166.

The amount of force applied by actuating system 153 may vary indifferent embodiments. Generally, the amount of force applied can beselected according to various different factors. For example, the amountof force applied can vary according to the type of tissue into which aplurality of prostheses is implanted. In particular, in some cases, agreater degree of force may be necessary for harder tissues such asbone. Less force may be necessary for implanting prostheses into softertissue. As another example, the amount of force applied by actuatingsystem 153 can vary according to size, material composition, and/orgeometry of one or more prostheses. In some embodiments, for example,the amount of force applied may vary according to the geometry of thedriving head of an anchor-type prosthesis.

In different embodiments, various different methods could be used tovary the force applied by actuating system 153. In embodiments includinga spring for storing energy, for example, the amount of pre-compressionof the spring could be changed through a dial or other mechanism. Anexample of a control knob for adjusting the compression of a spring isdiscussed in further detail below. In systems using electrical energystorage systems, the amount of electrical energy stored and/or appliedcould be adjustable. In still other embodiments, any other methods knownin the art for modifying the amount of force delivered, or otherwiseproduced, by an actuating system could be used.

Referring now to FIG. 7, once first prosthesis 162 has been implanted,surgeon 142 may prepare deployment device 150 to implant secondprosthesis 164. In the current embodiment, rotating portion 157 ofdeployment device 150 may be rotated in a direction represented by arrow198 until second prosthesis 164 comes into alignment with driving rod156. In FIG. 7, the initial position 171 of second prosthesis 164 priorto the rotation is indicated schematically in order to clearly show howthe position of second prosthesis 164 changes. It is contemplated thatthe adjustment of the position of second prosthesis 164 could beaccomplished through either a manual adjustment (as shown in FIG. 7) oran automatic adjustment. FIG. 7 illustrates the rotation of rotatingportion 157 as occurring in the direction represented by arrow 198.However, it will be understood that in some embodiments rotating portion157 may be rotated in an opposing direction to the direction representedby arrow 198. In other words, rotating portion 157 could be configuredto rotate in a clockwise and/or counterclockwise direction.

Referring now to FIG. 8, once second prosthesis 164 is aligned withdriving rod 156, surgeon 142 may associate delivery portion 172 with asecond location along tear 120. The second location may be disposedadjacent to the location of first prosthesis 164 in some cases. At thispoint, surgeon 142 may squeeze user activation device 158 (asrepresented by arrow 199) to release energy from energy storage system155 (see FIG. 5). This activates actuating system 153 and drives secondprosthesis 164 through tendon 106 and into humerus 102. In particular,second prosthesis 164 is impacted by driving rod 156, which moves in adirection indicated by arrow 197 during the expansion of spring 154.After first prosthesis 162 and second prosthesis 164 have been fullyimplanted, connecting member 166, which may comprise a suture thread,may be taut against tendon 106. This arrangement may facilitate theclosing of tear 120 of tendon 106 by anchoring connecting member 166 ata first location and a second location of tendon 106.

It may be useful to characterize the above sequence of operations interms of various configurations and/or stages of operation. For example,FIG. 5 may be seen to illustrate an initial configuration of deploymentdevice 150. In this initial configuration, first prosthesis 162 may bein a driving position while second prosthesis 164 may be in a storageposition. The driving position is a position within deployment device150 associated with implantation and may be further characterized as aposition in which a prosthesis is generally aligned, or otherwiseassociated with, actuating system 153. In some cases, first prosthesis162 may protrude sufficiently to be in contact with tissue for accurateimplantation (see FIGS. 15 and 16, for example). Therefore, a prosthesiscan be directly implanted from the driving position through theoperation of actuating system 153. The storage position is a positionwithin deployment device 150 that is generally out of alignment withactuating system 153, including driving rod 156. Therefore, a prosthesiscannot be implanted directly from the storage position, but must bemoved from the storage position to the driving position prior toimplantation. It should also be noted that in this initialconfiguration, connecting member 166 joins first prosthesis 162 andsecond prosthesis 164, as discussed above.

FIGS. 6 through 8 are seen to illustrate various stages of implantationduring the operation of deployment device 150. For example, in FIG. 6,first prosthesis 162 is implanted from a driving position into tendon106. Moreover, in this situation, connecting member 166 is seen to joinprosthesis 162 (now disposed outside of deployment device 150) andsecond prosthesis 164 (which remains within deployment device 150).Referring to FIG. 7, second prosthesis 164 may be moved from the storageposition into the driving position as described above. Finally, as seenin FIG. 8, second prosthesis 164 may be implanted from the drivingposition.

The method described here for implanting multiple prostheses mayfacilitate improvements in surgical techniques for repairing varioustypes of tissue imperfections, including, for example, rotator cufftears. By housing multiple prostheses in a single hand-held deploymentdevice, a surgeon can install multiple prostheses in relatively quicksuccession.

For purposes of clarity, the embodiments shown in FIGS. 5 through 8illustrate a plurality of prostheses 160 including two prostheses.However, other embodiments may include any other number of prostheseshoused within a single deployment device. In some cases, for example, adeployment device may be configured to house a single prosthesis. Instill other cases, a deployment device may be configured tosimultaneously house three or more prostheses.

FIGS. 9 through 11 illustrate embodiments of various possibleconfigurations for housing multiple prostheses in a deployment device.In particular, FIGS. 9 and 10 both illustrate schematic views of aforward end 182 of a deployment device 180 as well as correspondingcross-sectional views. FIG. 11 shows a schematic cross-sectional view ofdeployment device 180 when configured to house any other number ofprostheses. Referring first to FIG. 9, deployment device 180 may beconfigured to simultaneously house three different prostheses. Inparticular, deployment device 180 houses first prosthesis 185, secondprosthesis 186, and third prosthesis 187. Moreover, deployment device180 may also include driving device 184 that may be used to drive eachprosthesis into tissue. As with the embodiment discussed above and shownin FIGS. 5 through 8, each of first prosthesis 185, second prosthesis186, and third prosthesis 187 can be brought into alignment with drivingdevice 184 in order to implant each prosthesis in succession.

In some embodiments, two or more of first prosthesis 185, secondprosthesis 186, and third prosthesis 187 could be connected to oneanother. In other embodiments, none of the prostheses may be connected.In still other embodiments, each prosthesis may be connected to at leastone other prosthesis. In one embodiment, first prosthesis 185 may bejoined to second prosthesis 186. Also, second prosthesis 186 may bejoined to third prosthesis 187. This provides three prostheses that aredaisy-chained to one another. The connections discussed here could besuture threads or any other provisions for connecting two or moreprostheses.

Referring next to FIG. 10, in another embodiment, deployment device 180may be configured to simultaneously house five different prostheses. Inparticular, deployment device 180 houses first prosthesis 191, secondprosthesis 192, third prosthesis 193, fourth prosthesis 194, and fifthprosthesis 195. As with the embodiment discussed above and shown inFIGS. 5 through 8, each of first prosthesis 191, second prosthesis 192,third prosthesis 193, fourth prosthesis 194, and fifth prosthesis 195can be brought into alignment with driving device 184 in order toimplant each prosthesis in succession.

FIG. 11 illustrates an embodiment including N prostheses that are housedwithin deployment device 180 (shown only in schematic cross section). Inparticular, this embodiment includes first prosthesis 111, secondprosthesis 112, third prosthesis 113, fourth prosthesis 114, and fifthprosthesis 115. Additionally, Nth prosthesis 116 is also shown. It willbe understood that N may be any number. Moreover, it is to be understoodthat the general operation of implanting N prostheses housed within asingle deployment device may proceed in a manner similar to thatdiscussed above.

In some embodiments comprising multiple prostheses housed within asingle deployment device, the prostheses could be connected through theuse of one or more connecting members. For example, FIG. 12 illustratesa schematic view of an embodiment where first prosthesis 191, secondprosthesis 192, third prosthesis 193, fourth prosthesis 194, and fifthprosthesis 195 have been implanted through tendon 106 and into humerus102. In some embodiments, these prostheses may be connected to oneanother through connecting member 196. In this particular example, firstprosthesis 191, second prosthesis 192, third prosthesis 193, fourthprosthesis 194, and fifth prosthesis 195 may be daisy-chained togetherusing connecting member 196. In some embodiments, connecting member 196may comprise a suture thread that helps to tie down a portion of tendon106 against humerus 102. In some cases, first prosthesis 191, secondprosthesis 192, third prosthesis 193, fourth prosthesis 194, and fifthprosthesis 195 serve as suture anchors for connecting member 196.

Although the current embodiment illustrates an embodiment where fivedifferent prostheses are connected to one another using a singleconnecting member, other embodiments could use two or more separateconnecting members. In some cases, for example, adjacent pairs ofprostheses could be attached by distinct connecting members. Forexample, in an alternative embodiment, first prosthesis 191 and secondprosthesis 192 may be connected to one another using a first connectingmember, while second prosthesis 192 and third prosthesis 193 may beconnected to one another using a different second connecting member.Furthermore, although the approximate arrangement of prostheses in FIG.12 is generally an alternating or zig-zag configuration, otherembodiments may utilize any other suitable arrangement of prostheses inorder to repair tissue. Examples of other possible arrangements for twoor more anchors include, but are not limited to: lines, curves, variousshapes including triangular, rectangular as well as any other kindcontour and/or shape. The type of anchor arrangement could be selectedaccording to various factors including the type of imperfection or tear,the location of the imperfection, the type of surgical procedure,preferences of the surgeon, the type of connecting members being used aswell as possibly other factors.

General Overview of Tissue Repair System

FIGS. 13 through 15 illustrate isometric views of one embodiment oftissue repair system 200. In particular, FIGS. 13 and 14 illustrate anisometric view and an isometric partial exploded view, respectively, oftissue repair system 200, while FIG. 15 illustrates a cut-away view oftissue repair system 200.

Referring to FIGS. 13 through 15, tissue repair system 200 may comprisevarious sub-components including deployment device 202 and plurality ofprostheses 206. Deployment device 202 may comprise a body that includesa number of elements to assist in inserting and installing plurality ofprostheses 206. In some cases, deployment device 202 includes provisionsto move one or more of plurality of prostheses 206 into position.Moreover, in some cases, deployment device 202 includes provisions thatassociate one or more end portions of plurality of prostheses 206 withtissue such as tendon 106 (see FIGS. 1 and 2). In embodiments whereprostheses may articulate in some manner following installation (forexample, by expanding inside the implanted tissue), deployment device202 may further include provisions to facilitate articulation ofplurality of prostheses 206.

Deployment device 202 may generally be a hand-held device. In somecases, deployment device 202 may be configured for one-handed operationso that all of the various functions can be controlled with one hand.This arrangement allows plurality of prostheses 206 to be implantedusing a single hand.

Deployment device 202 may be further divided into two sub-assemblies,including a reusable base assembly 210 and a detachable front deliveryassembly 212. In some cases, base assembly 210 may comprise variouscomponents for generating an impact force that is used to deployplurality of prostheses 206. In some cases, front delivery assembly 212may include various components for transmitting forces generated withinbase assembly 210 to plurality of prostheses 206. As seen in FIG. 14,front delivery assembly 212 can be separated from base assembly 210.This allows base assembly 210 to be used with multiple differentdetachable front delivery systems, as discussed in further detail below.

Base assembly 210 may comprise various provisions to enhance usability.In some cases, base assembly 210 may include handgrip portion 214.Handgrip portion 214 may accommodate either the left or right hand of asurgeon. Although the design of handgrip portion 214 is showngenerically in these embodiments, other embodiments could be configuredwith various additional features. For example, in some otherembodiments, the geometry of handgrip portion 214 may be contoured toimprove grip. In still other embodiments, handgrip portion 214 couldcomprise various pads or similar portions that enhance traction andcomfort, as well as any other characteristics that improve usability.

Base assembly 210 may incorporate one or more activation devices thathelp to initiate implantation of a prosthesis. In one embodiment, baseassembly 210 may include trigger portion 216. Trigger portion 216 may besqueezed by one or more fingers in order to initiate implantation. Asdescribed in further detail below, trigger portion 216 may initiate asequence of actuating events that act to deploy and implant a prosthesisin a tissue such as bone.

In some embodiments, base assembly 210 can include provisions that allowa surgeon to adjust the magnitude of the impact force generated bycomponents of base assembly 210. For example, some embodiments couldinclude control knob 218. In some cases, control knob 218 may bedisposed at a rearward portion 211 of base assembly 210. In other cases,control knob 218 may be disposed along any other portion of baseassembly 210.

By turning control knob 218, a surgeon can modify the force generated bydeployment device 202. For example, a surgeon may turn control knob 218in a first direction in order to generally increase the force generatedby deployment device 202. Similarly, a surgeon may turn control knob 218in a second direction in order to generally decrease the force generatedby deployment device 202. In some cases, control knob 218 can beadjusted between discrete settings. In other cases, control knob 218 canbe adjusted between continuous settings.

Base assembly 210 can include provisions for constraining the motion ofone or more components, assemblies or systems disposed internally tobase assembly 210. As seen in FIGS. 13 and 14, base assembly 210 may beconfigured with retaining slot 267 (shown in phantom), which receives aprotruding portion 812 that is discussed in further detail below.

Although a single adjustment knob is shown in this example, otherembodiments could include still other adjustment devices. In particular,it will be understood that any other kinds of control devices could beused with base assembly 210. Examples of other types of control devicesinclude, but are not limited to: buttons, switches, knobs, touchdisplays, as well as any other devices or components. Moreover, in otherembodiments, one or more control devices could be used for purposes ofadjusting any other kinds of operating characteristics of deploymentdevice 202.

Front delivery assembly 212 may extend forwards from base assembly 210.In some embodiments, front delivery assembly 212 may have an elongatedgeometry. In some embodiments, for example, front delivery assembly 212has an approximately tube-like geometry. In some embodiments, rearwardend portion 213 of front delivery assembly 212 may be attached toforward portion 209 of base assembly 210. In addition, forward endportion 221 of front delivery assembly 212 may be configured to houseplurality of prostheses 206.

In some embodiments, front delivery assembly 212 includes attachmentassembly 220 that is configured to engage with forward portion 209 ofbase assembly 210. In some embodiments, front delivery assembly 212 maybe a detachable system that can easily be attached to, and detachedfrom, base assembly 210. Moreover, in some embodiments, front deliveryassembly 212 can be configured with additional features for changing thepositions of plurality of prostheses 206. These features are describedin further detail below.

Front delivery assembly 212 may also include cannula 215 that extendsforwardly from attachment assembly 220. In some cases, a lumen 217 ofcannula 215 may be sized to receive one or more prostheses, as well asadditional components that facilitate the driving and implantation ofprostheses. In some cases, cannula 215 could be an 8 mm cannula that isconfigured to house plurality of prostheses 206. In other cases,however, the size of cannula 215 could vary and may depend on the numberand size of prostheses housed within cannula 215. Moreover, cannula 215may be of any length necessary to achieve proper positioning forinstallation of plurality of prostheses 206.

Referring to FIG. 15, which illustrates some of the internal componentsof deployment device 202, base assembly 210 and front delivery assembly212 house various components that generate the required impact forces toimplant one or more prostheses. In some cases, base assembly 210 mayinclude trigger assembly 232, energy storage system 240, drivingassembly 250, and plurality of driven assemblies 260. The generaloperation of some of these components according to one embodiment isdescribed here. Trigger assembly 232, including trigger portion 216, maybe used to store energy in energy storage system 240 (for example, bycompressing a spring) and/or to release mechanical energy stored withinenergy storage system 240 (for example by releasing a compressedspring). This mechanical energy is converted into motion of drivingassembly 250. Driving assembly 250 may further impact, and drive, one ormore driven assemblies of plurality of driven assemblies 260. Thecorresponding driven assembly may then apply a force directly to one ofthe plurality of prostheses 206, which serves to deploy and implant theprosthesis. The details of trigger assembly 232, energy storage system240, driving assembly 250, and plurality of driven assemblies 260 arediscussed in further detail below.

Expandable Prostheses

FIG. 16 illustrates a schematic cut-away view of an embodiment ofplurality of prostheses 206 disposed within forward end portion 221 offront delivery assembly 212. As seen in FIG. 16, plurality of prostheses206 may further include first prosthesis 270 and second prosthesis 272.In some embodiments, first prosthesis 270 and second prosthesis 272 maybe substantially similar. In other embodiments, however, firstprosthesis 270 and second prosthesis 272 may be substantially differentin shape, size, and/or materials. For the present embodiments, it may beassumed that first prosthesis 270 and second prosthesis 272 aresubstantially similar. In particular, the following figures andaccompanying description focus on the features of first prosthesis 270,though it should be understood that similar principles may also apply tosecond prosthesis 272.

Although one particular embodiment of prostheses 206 is illustrated inthe figures, the size, shape, and other characteristics of prostheses206 may be determined based on a number of factors, potentiallyincluding the size and shape of the imperfection; the condition and typeof tissue into which prostheses 206 are to be deployed; and the type andamount of circumferential or other stress that is to be exerted byprostheses 206 on the surrounding tissue. The prostheses 206 may be madein a variety of shapes, as appropriate for different size incisions,cuts, holes, condition of patient, and method of repair. Additionally,although FIG. 16 illustrates an embodiment of prostheses 206 in whichboth first prosthesis 270 and second prosthesis 272 are of roughly equalsize, other embodiments could incorporate two or more prostheses ofdifferent sizes. For example, it may be desirable to make one of firstprosthesis 270 or second prosthesis 272 larger if needed to providesuitable anchoring for a detached tendon at adjacent tissue locationswith varying properties such as size or density. Moreover, it should beunderstood that the length of any suture or other kind of connectingmember that connects first prosthesis 270 and second prosthesis 272could be varied in order to accommodate various spacings between firstprosthesis 270 and second prosthesis 272 following implantation. Forpurposes of clarity, first prosthesis 270 and second prosthesis 272 areshown without a connecting member attached between them, though acorresponding connecting member 830 between first prosthesis 270 andsecond prosthesis 272 is shown in FIGS. 61 through 63.

In the embodiment shown in FIG. 16, first prosthesis 270 and secondprosthesis 272 may temporarily be mounted to components of plurality ofdriven assemblies 260. As one of plurality of driven assemblies 260 isimpacted by driving assembly 250 (see FIG. 15), first prosthesis 270and/or second prosthesis 272 may be deployed from forward end portion221. However, other embodiments may utilize different mechanisms forimplanting first prosthesis 270 and/or second prosthesis 272 intotissue. In other words, it should be understood that the prosthesesshown in the figures are not limited to use with a particular kind ofdeployment device.

FIGS. 17 and 18 illustrate isometric views of an embodiment of firstprosthesis 270, or simply prosthesis 270. Specifically, FIG. 17illustrates a first isometric view of prosthesis 270, while FIG. 18illustrates a second isometric view of prosthesis 270 in whichprosthesis 270 has been rotated approximately 90 degrees around acentral axis 271. For purposes of clarity, prosthesis 270 is shown inisolation from components of a deployment device and/or additionalprostheses.

As previously discussed with respect to earlier embodiments of aprosthesis, prosthesis 270 may be adapted to repair a flaw,imperfection, cut, incision, hole, or tear in a tissue or collection oftissues. One possible application is the repairing of a rotator cufftendon tear. However, the use of prosthesis 270 is not limited to thisparticular application and could be generally applied in a variety ofdifferent situations. For example, prosthesis 270 could also be used torepair any other kinds of tendons, muscles, fascia, bone, cartilage,meniscus, ligaments, or skin.

In some embodiments, prosthesis 270 may function as an anchor for asuture that may facilitate repair of a tear or other kind ofimperfection. In other embodiments, prosthesis 270 could function as ananchor for any other kind of prosthetic devices apart from sutures.Still other embodiments could utilize prosthesis 270 for directlyattaching or otherwise fastening adjacent tissues together.

The geometry of prosthesis 270 could vary from one embodiment toanother. In one embodiment, prosthesis 270 may have the approximategeometry of a screw or similar fastening device. In some embodiments,prosthesis 270 may include a driving portion 274 that is disposed at oneend of an elongated base portion 290. In other embodiments, however,prosthesis 270 could have any other approximate geometry that issuitable for repairing a particular type of imperfection.

In some embodiments, driving portion 274 is configured with a drivingtip portion 275. Driving tip portion 275 may have a tapered or slopedforward surface 276 that facilitates penetration. In some embodiments,driving tip portion 275 may have an approximately conical geometry thatmay be approximately symmetrical about central axis 271. In otherembodiments, however, the geometry of driving tip portion 275 couldvary. For example, in other embodiments, the geometry of driving tipportion 275 could be substantially irregular or asymmetric. Moreover, insome embodiments driving tip portion 275 could be configured withadditional features such as cavities, projections, mechanical threads orany other geometric features that could enhance and/or controlimplantation.

In some embodiments, driving portion 274 may include hole 277. In somecases, hole 277 may be a through-hole configured to receive one or moresuture threads. For example, one or more suture threads may be insertedthrough hole 277 in order to fasten the one or more suture threads toprosthesis 270. In some cases, the end of a suture thread may be fedthrough hole 277 and tied in order to anchor the end of the suturethread in place. In other cases, an intermediate portion of a suturethread could be fed through, looped around, or otherwise associated withhole 277. This arrangement may allow intermediate sections of a suturethread to be anchored in place. In still other embodiments, drivingportion 274 could incorporate two or more holes. Such configurationswould allow for the attachment of different connecting portions atdriving portion 274.

In some embodiments, hole 277 may be disposed in central portion 273 ofdriving portion 274. In other embodiments, however, hole 277 could bedisposed in any other portion of driving portion 274. In still otherembodiments, hole 277 could be disposed in base portion 290. Inembodiments where multiple suture threads may be used, prosthesis 270could be provided with multiple holes.

In some embodiments, driving portion 274 may also include wedge portion278. In some cases, wedge portion 278 extends away from driving tipportion 275 towards base portion 290. Wedge portion 278 may generallyhave a wedge-like shape that is configured to interact with an end ofbase portion 290, as described in further detail below. In oneembodiment, wedge portion 278 can include a first wedge surface 279 anda second wedge surface 280 that meet along an edge 282.

In some embodiments, base portion 290 comprises a first longitudinalportion 291 and a second longitudinal portion 292 that extend along thelength of base portion 290. First longitudinal portion 291 and secondlongitudinal portion 292 may be joined at a rearward portion 293 of baseportion 290. In some embodiments, rearward portion 293 has a ring-likegeometry that is approximately symmetric about central axis 271. Inaddition, in some embodiments, first longitudinal portion 291 and secondlongitudinal portion 292 may be separated from rearward portion 293 to aforward portion 294 of base portion 290. In some embodiments, firstlongitudinal portion 291 and second longitudinal portion 292 maygenerally remain separated at forward portion 294.

In some embodiments, base portion 290 includes longitudinal slot 295,which is clearly seen in FIG. 17. In some embodiments, longitudinal slot295 may extend through the diameter of base portion 290 and maygenerally be seen as dividing first longitudinal portion 291 from secondlongitudinal portion 292. In some cases, longitudinal slot 295 may becharacterized as oriented in a lateral direction to an implantationdirection of prosthesis 270. In addition, in some embodiments, baseportion 290 incorporates a longitudinal cavity 296 that extends throughthe entire length of base portion 290. In some embodiments, longitudinalcavity 296 may intersect longitudinal slot 295.

Longitudinal cavity 296 may facilitate various kinds of functionalityfor prosthesis 270. In some embodiments, longitudinal cavity 296 may beshaped and sized to receive a driven rod, pin, or similar component froma driven assembly and/or driving assembly. For example, the currentembodiment illustrates a generally circular cross section forlongitudinal cavity 296 and opening 299 in order to receive a generallycylindrical pin or rod that can apply a force directly to drivingportion 274.

Longitudinal slot 295 may facilitate various kinds of functionality forprosthesis 270. In one embodiment, longitudinal slot 295 may facilitatethe alignment of one or more suture threads along prosthesis 270. Forexample, in some embodiments a suture thread that is tied through hole277 may extend within longitudinal slot 295 towards rearward portion 293of base portion 290. An example of such an arrangement is described indetail below. This may allow for some protection of the suture thread asit is housed within a deployment device and/or during implantation intotissue and anchor expansion.

In some embodiments, base portion 290 and driving portion 274 may beattached at first connecting portion 310 and second connecting portion398. In some embodiments, base portion 290 may be connected directly towedge portion 278 of driving portion 274. In some embodiments, firstlongitudinal portion 291 and second longitudinal portion 292 may beconnected to first wedge surface 279 and second wedge surface 280,respectively. In other embodiments, however, base portion 290 anddriving portion 274 may not be attached, but instead may be held inrelation to one another using a driving pin or similar component.

Some embodiments of prosthesis 270 may include provisions for grasping,gripping, or otherwise embedding prosthesis 270 into tissue such thatprosthesis 270 resists removal from the tissue once inserted. In someembodiments, prosthesis 270 could include plurality of projectingportions 297 that extend from base portion 290. In some cases, pluralityof projecting portions 297 may extend in a lateral direction to theimplantation direction of prosthesis 270. For example, the presentembodiments illustrate prosthesis 270 with five projecting portions 297.However, other embodiments could include any other number of projectingportions 297. For example, some other embodiments could include one,two, three, or more projecting portions.

Plurality of projecting portions 297 may include first projectingportion 298. In some embodiments, first projecting portion 298 may berepresentative of the remaining projecting portions in plurality ofprojecting portions 297. In the current embodiment, for example, each ofplurality of projecting portions 297, including first projecting portion298, may be substantially similar in geometry, size, and/or othercharacteristics. However, other embodiments could comprise two or moreprojecting portions that vary in geometry, size, and/or orientation. Byvarying the size, geometry, and/or orientation of two or more projectingportions, the anchoring properties of prosthesis 270 could be variedalong the length of base portion 290.

In some cases, first projecting portion 298 comprises a first surface302 and a second surface 304. First surface 302 may be oriented suchthat first surface 302 is approximately perpendicular to central axis271 of prosthesis 270. In contrast, in some cases, second surface 304may be oriented at an acute angle with respect to central axis 271. Insome embodiments, second surface 304 slopes downwardly from theintersection of second surface 304 with first surface 302 towardsforward portion 294 of base portion 290. In one embodiment, secondsurface 304 may be sloped in a manner to facilitate, or reduceresistance to, the insertion of prosthesis 270 into a tissue. Inaddition, first surface 302 may be oriented in a way that helps resistremoval of prosthesis 270 from a tissue. This configuration helps tofirmly anchor prosthesis 270 into place within a tissue.

Although the current embodiment illustrates a particular geometry forplurality of projecting portions 297, other embodiments could includeany other kinds of structures that help to anchor prosthesis 270 intoplace following implantation. For example, in other embodiments,prosthesis 270 may include a plurality of barb-like projections. Theshape, geometry, and/or other structural characteristics of projectionsextending from prosthesis 270 could vary according to various factorssuch as the type of tissue being repaired, the materials comprisingprosthesis 270, as well as the method of implantation.

Some embodiments can include additional provisions for anchoringprosthesis 270 in place within bone or any other tissue. For example,some embodiments can include provisions that allow some portions ofprosthesis 270 to expand as prosthesis 270 is implanted. In someembodiments, base portion 290 may be configured to expand as prosthesis270 is implanted.

FIGS. 19 through 22 illustrate schematic side views of variousconfigurations of prosthesis 270 during implantation into tissue 330.Tissue 330 is shown here as boney material. However, it should beunderstood that a similar process of implantation may occur withinvarious other kinds of tissue, including both hard and soft tissues.

Some embodiments of a prosthesis may include provisions to help anchorthe prosthesis within a tissue. In some embodiments, some portions of aprosthesis may be configured to expand once the prosthesis has beeninserted into a tissue. In some embodiments, implanting a prosthesis mayoccur in two stages, including a first stage where the prosthesis isdriven to a predetermined depth within the tissue and a second stagewhere at least one portion of the prosthesis expands.

Referring first to FIG. 19, prosthesis 270 may be aligned with thedesired region of tissue 330 prior to implantation. In some embodiments,prosthesis 270 may be housed within deployment device 202 (not shown).However, in other embodiments, prosthesis 270 may be associated with anyother device or tools for implanting prosthesis 270, including devicesor tools that facilitate manual implantation. As previously discussed,in some embodiments a driven rod, pin, or similar component (not shown)may extend through longitudinal cavity 296 (see FIG. 17) of base portion290. This allows an initial driving force to be applied directly todriving portion 274, as well as base portion 290. In other embodiments,however, the initial driving force could be applied directly to baseportion 290 rather than driving portion 274. In still other embodiments,the initial driving force could be applied directly to driving portion274 rather than base portion 290.

Referring next to FIG. 20, a first force 340 may be applied toprosthesis 270 at driving portion 274. In some embodiments, a secondforce 341 may simultaneously be applied to prosthesis 270 at rearwardportion 293 of base portion 290. The result of first force 340 andsecond force 342 may be to drive prosthesis 270 into tissue 330. In somecases, first force 340 and second force 342 may act to drive prosthesis270 to a depth D1 within tissue 330. In some cases, first force 340and/or second force 342 may be selected to achieve a particularimplantation depth. This depth can be chosen according to variousfactors including tissue structure, the type of repair being made, andthe desired position of rearward portion 293 at the completion of thefirst stage of implantation. Note that while in some embodimentsrearward portion 293 may extend outwardly from tissue 330 following thisfirst stage of implantation, the final position of rearward portion 293can change during a second stage of implantation as described below.

In some embodiments, a second stage of implantation occurs as firstforce 340 ceases (or is substantially reduced) while second force 342continues to apply a driving force to base portion 290. During thissecond stage, driving portion 274 may remain substantially in placewhile base portion 290 is driven further into tissue 330 andsimultaneously expands in the radial direction.

In some embodiments, first connecting portion 310 and second connectingportion 398 may be configured such that base portion 290 and drivingportion 274 can separate under a predetermined amount of force, e.g.,first connecting portion 310 and second connecting portion 398 may beseparable. In some embodiments, the geometry and/or thickness of firstconnecting portion 310 and second connecting portion 398 can becontrolled so that base portion 290 and driving portion 274 separate asa predetermined amount of force is applied. In other embodiments, thematerial composition of first connecting portion 310 and secondconnecting portion 398 could be selected to achieve separation of baseportion 290 and driving portion 274 under the predetermined amount offorce. During the first stage of implantation, the simultaneousapplication of first force 340 and second force 342 results in asubstantially low net force in the region of first connecting portion310 and second connecting portion 398. However, in the second stage ofimplantation, the decrease in first force 340 creates a net force in theregion of first connecting portion 310 and second connecting portion398, which may act to deform and eventually separate first connectingportion 310 and second connecting portion 398.

Referring to FIG. 21, second force 342 is applied at rearward portion293 of base portion 290. The magnitude of second force 342 may be suchthat base portion 290 separates from driving portion 274 at firstconnecting portion 310 and second connecting portion 398. With baseportion 290 separated, second force 342 acts to push forward portion 294against wedge portion 278. As seen here, wedge portion 278 may driveinto forward portion 294, which has the effect of driving firstlongitudinal portion 291 and second longitudinal portion 292 apart atforward portion 294.

In some embodiments, base portion 290 is driven further into tissue 330under the continued application of second force 342. As base portion 290continues to penetrate farther into tissue 330, driving portion 274,which remains approximately stationary within tissue 330, acts tofurther separate first longitudinal portion 291 and second longitudinalportion 292, as shown in FIG. 22.

Referring to FIG. 23, the end of the second stage of implantation mayoccur when wedge portion 278 is disposed directly adjacent to rearwardportion 293 of base portion 290. In some cases, as seen in FIG. 23,rearward portion 293 may be recessed with respect to outer surface 331of tissue 330. In other cases, rearward portion 293 may be approximatelyflush with outer surface 331. In still other cases, rearward portion 293may extend outwardly from outer surface 331. The depth of rearwardportion 293 relative to outer surface 331 may vary in differentembodiments according to various factors such as the type of tissue, themagnitude of the forces applied to the prosthesis, the condition of thepatient, the method of repair, the surgeon's preference, as well as thegeometry and material composition of the prosthesis. Moreover, thesevarious factors may be tuned in order to achieve a desired implantationdepth.

The configuration of prosthesis 270 following the first and secondstages of implantation helps anchor prosthesis 270 within tissue 330.Any suture placed within hole 277 could extend along base portion 290and apply tension along an outward direction from tissue 330. Thesplayed configuration of first longitudinal portion 291 and secondlongitudinal portion 292 may help resist outward movement of prosthesis270. In some cases, plurality of projecting portions 297 (FIG. 17) mayfurther help to secure prosthesis 270 within tissue 330. In particular,each of the projecting portions may generally project outwardly frombase portion 290 to increase the resistance of base portion 290 to beingremoved.

Some embodiments may include provisions for helping to ensure aprosthesis expands properly during implantation. In some embodiments, aprosthesis may be provided with provisions that help to maintain axialalignment of driving portion 274 and base portion 290, which mayfacilitate proper engagement between base portion 290 and wedge portion278 as discussed in further detail below. Referring back to FIG. 17, inone example, wedge portion 278 may include first projecting feature 301and second projecting feature 303, which extend from first wedge surface279 and second wedge surface 280, respectively. Moreover, base portion290 may comprise corresponding track-like features along interiorsurface 399. In some embodiments, first projecting feature 301 andsecond projecting feature 303 have convex rounded cross-sectional shapesthat correspond with the concave cross-sectional shapes of interiorsurface 399 of base portion 290. Thus, as first wedge surface 279 andsecond wedge surface 280 engage base portion 290 and begin splittingfirst longitudinal portion 291 and second longitudinal portion 292apart, first projecting feature 301 and second projecting feature 303may enter corresponding tracks or channels along interior surface 399 ofbase portion 290. This may help to maintain the desired axial alignmentbetween driving portion 274 and base portion 290 throughoutimplantation.

In some embodiments, driving portion 274 and base portion 290 mayinclude cooperating features to help resist back-out, or any tendencyfor base portion 290 to move rearwardly away from driving portion 274.In particular, these features may help lock driving portion 274 and baseportion 290 together at various stages of implantation and especiallyonce prosthesis 270 has been fully implanted (i.e. base portion hasfully expanded). In some embodiments, wedge portion 278 could beconfigured with surface features that engage corresponding recesses ornotches in base portion 290 in order to restrict any tendency of baseportion 290 to back away from driving portion 274, as well as to lockdriving portion 274 and base portion 290 together at the end of theimplantation process. Some embodiments could include notches within baseportion 290 that receive corresponding features or protrusions ondriving portion 274 in order to resist rearward motion of base portion290 during implantation. Examples of various cooperating orcorresponding surfaces and/or surface features may include, but are notlimited to, protrusions that engage corresponding recesses,corresponding ridged surfaces, corresponding teeth, as well as any otherfeatures. In some embodiments, this arrangement may have the effect ofpreventing driving portion 274 from moving further into tissue 330 (seeFIG. 23). Additionally, this arrangement may also help prevent baseportion 290 from moving in a direction opposite of implantation.

In one embodiment, as seen in FIG. 17 and FIG. 19, prosthesis 270 maycomprise first barbed portion 391 and second barbed portion 393 that aredisposed on driving portion 274. In some embodiments, first barbedportion 391 and second barbed portion 393 may be configured to engageplurality of notch-like portions 395 that are disposed on interiorsurfaces of plurality of projecting portions 297. As shown in FIGS. 21through 23, as prosthesis 270 expands, first barbed portion 391 andsecond barbed portion 393 may engage notch-like portions 395 of rearwardportion 293 of base portion 290.

In some embodiments, the features described here may work together tohelp prosthesis 270 to expand in the desired manner during implantation.For example, as prosthesis 270 begins to expand, first projectingfeature 301 and second projecting feature 303 may engage correspondingtracks or grooves of interior surface 399 of base portion 290 in orderto guide and prevent the separation of driving portion 274 and baseportion 290 and maintain the desired axial alignment. Simultaneously, asbase portion 290 expands, first barbed portion 391 and second barbedportion 393 engage notch-like portions 395 within base portion 290,which prevents relative movement and back-out and helps ensure thatdriving portion 274 and base portion 290 do not move apart along theaxial direction. Moreover, these features work together to lockprosthesis 270 in a fully expanded position once the implantationprocess is complete.

FIG. 24 illustrates an isometric view of an alternative embodiment of aprosthesis 350. Prosthesis 350 could share some similar characteristicswith prosthesis 270 described above. For example, prosthesis 350 mayinclude a driving portion 352 and a base portion 360. Moreover, baseportion 360 can be divided into a first longitudinal portion 361 and asecond longitudinal portion 362 that are separated by longitudinalcavity 364 as well as longitudinal slot 365. In some embodiments, baseportion 360 may also include plurality of ridged portions 366.

In contrast to the previous embodiment, however, the embodiment shown inFIG. 24 includes a separate wedge portion 370. In some embodiments,wedge portion 370 and driving portion 352 may be disposed on opposingend portions of base portion 360. In addition, first longitudinalportion 361 and second longitudinal portion 362 are separated atrearward portion 368, which is disposed adjacent to wedge portion 370.Also, first longitudinal portion 361 and second longitudinal portion 362may be connected at forward portion 369, which is disposed adjacent todriving portion 352.

In some embodiments, wedge portion 370 can include one or more channelsor holes. In some embodiments, wedge portion 370 can include hole 372that extends through the entirety of wedge portion 370. In someembodiments, hole 372 may be aligned with longitudinal cavity 364 ofbase portion 360. In one embodiment, hole 372 and longitudinal cavity364 may be configured to receive a rod, pin, or similar device that canbe inserted through base portion 360. This allows a force to be applieddirectly to forward portion 369 of base portion 360, which is adjacentto driving portion 352.

FIGS. 25 through 28 illustrate schematic side views of severalconfigurations of prosthesis 350 during implantation into tissue 380. Aswith the previous embodiment, the process of implanting prosthesis 350may generally occur in two stages. During a first stage, prosthesis 350may be driven to a predetermined depth D2 into tissue 380 (as seen inFIG. 26). Following this, during a second stage, base portion 360 ofprosthesis 350 may undergo expansion within tissue 380 (as seen in FIGS.27 and 28).

Referring to FIG. 25, prior to implantation, prosthesis 350 may bealigned with the desired region of tissue 380. Next, as seen in FIG. 26,a first force 390 may be applied to forward portion 369. In someembodiments, a second force 392 may be simultaneously applied to wedgeportion 370. The application of first force 390 and second force 392 mayhelp to drive prosthesis 350 into tissue 380. This comprises the firststage of implantation in which driving portion 352 is inserted to adepth D2.

As seen in FIG. 27, the second stage of implantation begins as firstforce 390 ceases or substantially decreases in magnitude while secondforce 392 continues to be applied to wedge portion 370. At this point,the magnitude of second force 392 may be such that wedge portion 370separates from base portion 360. Once separated from base portion 360,wedge portion 370 may be driven into rearward portion 368. Moreover, asshown in FIG. 27, wedge portion 370 acts to separate first longitudinalportion 361 and second longitudinal portion 362 of base portion 360.Finally, as seen in FIG. 28, wedge portion 370 may be disposed adjacentto driving portion 352 after the implantation process has beencompleted.

The configuration of prosthesis 350 following the first and secondstages of implantation helps anchor prosthesis 350 within tissue 380.Any suture secured at driving portion 352 could extend around wedgeportion 370 and apply tension along an outward direction from tissue380. The splayed configuration of first longitudinal portion 361 andsecond longitudinal portion 362 helps resist outward movement ofprosthesis 350. In some embodiments, plurality of ridged portions 366may further help to secure prosthesis 350 within tissue 380.

As described earlier, some embodiments of a prosthesis can includeportions that have corresponding or cooperating surfaces (including bothtextures and/or other surface features). In the embodiments shown inFIGS. 24 through 28, wedge portion 370 and base portion 360 may beconfigured with cooperating surface textures or features in order toreduce or substantially eliminate movement that may otherwise separatewedge portion 370 and base portion 360 both during and afterimplantation. Examples of various cooperating or corresponding surfacesand/or surface features may include, but are not limited to, protrusionsthat engage corresponding recesses, corresponding ridged surfaces,corresponding teeth, track-like features, as well as any other features.In some embodiments, for example, wedge portion 370 includes surfacetextures or features that cooperate with corresponding textures orfeatures of an interior surface of longitudinal cavity 364. Therefore,as wedge portion 370 drives into base portion 360 and acts to expand orsplay base portion 360, surface features of wedge portion 370 may engagesurface features of the interior surface of longitudinal cavity 364 tohelp prevent wedge portion 370 from axial misalignment with base portion360 during or after implantation. In particular, these provisions helpresist movement in a direction opposite of implantation, once prosthesis350 has been fully implanted.

The prostheses of the above described embodiments (including theembodiments shown in FIGS. 17 through 23 as well as the embodimentsshown in FIGS. 24 through 28) are configured to split, or splay, intotwo portions. In other embodiments, a prosthesis could be configured tosplit into three or more portions. In some embodiments, for example, thebase portion of a prosthesis could be configured as three or moredistinct portions that are separated by various slots as well as alongitudinal cavity.

FIGS. 29 and 30 illustrate schematic views of an embodiment of aprosthesis 400 that is configured to separate into three distinctportions under a predetermined force. In particular, FIG. 29 illustratesa schematic isometric view of prosthesis 400 including an enlargedcut-away view. FIG. 30 illustrates a schematic view of prosthesis 400where base portion 460 has been expanded. Referring to FIGS. 29 and 30,prosthesis 400 may share some similar characteristics with prosthesis350 described above. For example, prosthesis 400 may include a drivingportion 452 and a base portion 460. For purposes of clarity, only someof the shared features between prosthesis 400 and prosthesis 350 aredescribed here.

In the current embodiment, base portion 460 comprises three distinctportions. Specifically, in this case, base portion 460 comprises firstlongitudinal portion 461, second longitudinal portion 462, and thirdlongitudinal portion 463. First longitudinal portion 461, secondlongitudinal portion 462, and third longitudinal portion 463 may beseparated by first longitudinal slot 464, second longitudinal slot 465,and third longitudinal slot 466, as well as longitudinal cavity 468.

As shown in FIG. 30, first longitudinal portion 461, second longitudinalportion 462, and third longitudinal portion 463 may each be configuredto expand, or splay, outwardly. In some embodiments, the splaying offirst longitudinal portion 461, second longitudinal portion 462, andthird longitudinal portion 463 occurs as splitting member 470 is driveninto base portion 460. Splitting member 470 could be similar in somerespects to wedge portion 370 of the previous embodiment. In someembodiments, splitting member 470 may be configured with a geometry toapply approximately equal outward forces against first longitudinalportion 461, second longitudinal portion 462, and third longitudinalportion 463.

FIG. 31 illustrates schematic cut-away views of two more alternativeembodiments of prostheses with expandable base portions. Referring toFIG. 31, prosthesis 430 is configured with four distinct portions thatmay split apart from one another during implantation. Prosthesis 440 isconfigured with five distinct portions that may split apart duringimplantation. Moreover, prosthesis 430 and prosthesis 440 are only shownas further possible embodiments. Additional embodiments are not limitedto any particular number of distinct portions and could include, forexample, six separate portions, seven separate portions, or any othernumber of portions. It should be understood that the number of portionsof a prosthesis that may be pre-configured to split apart as theprosthesis is implanted may depend on a variety of factors includinggeometry and material of the prosthesis, the method of repair employedby the surgeon, as well as the type of tissue into which a prosthesismay be deployed. Furthermore, while the embodiments described aboveinclude portions that are generally arranged in a symmetric manner abouta central axis of the prosthesis, other embodiments could incorporateportions that are arranged in an asymmetric manner about a central axis.

In different embodiments, the size, shape, and other characteristics ofa prosthesis may vary. Generally, the size, shape, and othercharacteristics could be determined based on a number of factors. Thesefactors may potentially include the size and shape of the correspondingimperfection; the condition and type of tissue into which the prosthesisis to be deployed; the type and amount of stress that is to be exertedby the prosthesis on the surrounding tissue; and the method of repairemployed by the surgeon.

The prostheses described above and shown in the figures may be made of avariety of materials. In some cases, a prosthesis may be made using abiocompatible material that is sufficiently rigid to anchor a suture forrepairing tendons, yet sufficiently compliant so as to avoid furtherdamaging the tendon should slight relative motion between the tendon (oradjacent tissue) and the prosthesis occur. Examples of suitablematerials include polymers such as nylon, prolene, dacron, ultra highmolecular weight polyethylene (UHMWPE), and other suitable materials.Some examples of suitable bioabsorbable materials are: poly L-lacticacid (PLLA), polyglycolic acid (PGA). A prosthesis can also be formed ofother possible materials, including polymers and metals such aspolytetrafluorethylene (PTFE), polyaryletherketone (PAEK),polyetheretherketone (PEEK), polyoxymethylene (acetal), polycarbonate,polysulfone, silicone elastomers, commercially pure titanium, titaniumalloys, CoCr alloys, nickel titanium (nitinol) alloys, and implant gradestainless steels. In some embodiments, a prosthesis may be formed of abioabsorbable polymer that is gradually absorbed by the body. Stillother possible materials for a prosthesis include composites, such ascarbon fiber composites and ceramics. It will be understood that thematerials used for a prosthesis are not limited and a variety ofdifferent materials could be used according to desired characteristicsfor the prosthesis.

Prostheses including multiple longitudinal portions can be manufacturedas single monolithic parts in some cases. For example, some embodimentsmay include prostheses comprising a substantially monolithic material,such as a bioabsorbable polymer that may be molded to the desired shape.In still other embodiments, however, longitudinal portions of aprosthesis could be formed separately and joined in a later stage ofmanufacturing.

Impact System

A surgeon may install one or more prostheses during a surgical procedureto repair damaged or otherwise imperfect tissue by manually insertingthe one or more prostheses, with or without the help of additionaltools. As previously discussed, however, a deployment device may also beused to install one or more prostheses.

FIGS. 32 and 33 illustrate isometric cut-away views of deployment device202 according to one embodiment. In particular, FIG. 32 illustrates anisometric cut-away view of forward end portion 221 of front deliveryassembly 212 as well as the rearward end portion 214 of front deliveryassembly 212. FIG. 33 illustrates an isometric cut-away view of aportion of deployment device 202 including base assembly 210 andrearward end portion 214 of front delivery assembly 212.

Referring first to FIG. 32, components of base assembly 210 and frontdelivery assembly 212 may cooperate to implant one or more prostheses.As described earlier and shown in FIGS. 19 through 23, first prosthesis270 may be implanted into tissue through a two stage implantationprocess. During a first stage a first force may be applied directly todriving portion 274 and base portion 290 of prosthesis 270 to drivefirst prosthesis 270 to a predetermined depth within a tissue. During asecond stage a force may be applied only to base portion 290 ofprosthesis 270 in order to expand base portion 290 within the tissue. Toaccommodate this two stage process, deployment device 202 canincorporate a two stage impact and driving mechanism to implant firstprosthesis 270. This two stage impact and driving mechanism maysimilarly be used to implant second prosthesis 272.

In some embodiments, plurality of prostheses 206 may be associated withcomponents of plurality of driven assemblies 260. In some embodiments,first prosthesis 270 may be associated with first driven tube 502 andfirst driven pin 504. First driven pin 504 may be coaxially locatedwithin a hollow longitudinal cavity 510 (see FIG. 34) of first driventube 502. In some embodiments, first driven pin 504 may be capable oftranslating through hollow longitudinal cavity 510 of first driven tube502.

In some embodiments, first prosthesis 270 may be associated with endportions of first driven tube 502 and first driven pin 504. In someembodiments, first end portion 512 (see FIG. 32) of first driven pin 504may be inserted into longitudinal cavity 296 (see FIG. 17) of firstprosthesis 270. In some cases, first end portion 512 may further bedisposed adjacent to driving portion 274, which may allow first drivenpin 504 (FIG. 32) to apply a force directly to driving portion 274during implantation. Additionally, in some embodiments, first endportion 514 of first driven tube 502 may be disposed adjacent torearward portion 293 of base portion 290. This arrangement may allowfirst driven tube 502 to apply a force directly to base portion 290during implantation.

Referring to FIG. 32, in some embodiments, second prosthesis 272 maylikewise be associated with second driven tube 506 and second driven pin508. In some cases, the arrangement of second prosthesis 272 with seconddriven tube 506 and second driven pin 508 may be substantially similarto the relationship described above between first prosthesis 270, firstdriven tube 502 and first driven pin 504. In some embodiments, forexample, second driven tube 506 may include a hollow longitudinal cavitythrough which second driven pin 508 may translate. For purposes ofreference, first driven tube 502 and first driven pin 504 may becollectively referred to as first driven assembly 261 while second drivetube 506 and second driven pin 508 may be collectively referred to assecond driven assembly 262.

First prosthesis 270 may or may not be joined with first driven tube 502and/or first driven pin 504. In some embodiments, for example, firstdriven pin 504 may simply be inserted within first prosthesis 270,without being directly attached. In some embodiments, a frictional fitcould be formed between first driven pin 504 and first prosthesis 270.Likewise, in some embodiments, first driven tube 502 could be disposedadjacent to, but not joined with, first prosthesis 270. In otherembodiments, first prosthesis 270 could be temporarily joined with firstdriven pin 504 and/or first driven tube 502. Various joining methodscould be used including, but not limited to, adhesives and mechanicalconnectors. Further examples of provisions for joining first prosthesis270 with first driven pin 504 and/or first drive tube 502 include, butare not limited to: ridges, annular rings, frictional fits andthreading. For example, in some embodiments, a driven pin and aprosthesis could have corresponding threaded portions, which could allowthe driven pin to be screwed into the prosthesis. It will be understoodthat in embodiments where first prosthesis 270 may be attached to firstdriven tube 502 and/or first driven pin 504, this attachment could betemporary and these components may be easily and/or automaticallyseparated during the implantation process so that only first prosthesis270 remains implanted in the tissue. The specific provisions used forretaining the prosthesis on the driven pin can vary and in differentembodiments could be selected according to: materials of the pin and/orprosthesis; type of tissue into which the prosthesis is to be implantedas well as possibly other factors.

As seen in FIG. 32, some embodiments of front delivery assembly 212 mayinclude guide member 581. In some embodiments, guide member 581 isconfigured to control the alignment of first driven tube 502, firstdriven pin 504, second driven tube 506 and second driven pin 508.Moreover, in some cases, guide member 581 is configured with a groovefor receiving one or more o-rings. One or more o-rings may be used toseal out fluids and may also provide sufficient friction to maintainaxial advancement of each driven tube during impact with driving tube520.

The following discussion makes reference to the implantation of firstprosthesis 270 using first driven tube 502 and first driven pin 504, incombination with other components of deployment device 202. However, itshould be understood that the discussion may equally apply to theimplantation of second prosthesis 272. As discussed later, the locationsof second prosthesis 272, second driven tube 506 and second driven pin508 within front delivery assembly 212 can be interchanged with firstprosthesis 270, first driven tube 502, and first driven pin 504,respectively. Therefore, the operation of implanting second prosthesis272 may be substantially similar to the operation of implanting firstprosthesis 270. Moreover, in some embodiments, the process of implantingfirst prosthesis 270 and second prosthesis 272 makes use of the samecomponents within base assembly 210 for impacting and driving theassociated driven pin and driven tube.

Using the arrangement described here for first prosthesis 270, baseassembly 210 can include provisions for applying the desired forces tofirst driven tube 502 and first driven pin 504. Specifically, in somecases, base assembly 210 may be configured to deliver at least twoforces of possibly varying magnitudes and in a predetermined sequencethat coincide with the two stage implantation of first prosthesis 270.In some embodiments, this is accomplished using a driving tube 520 anddriving pin 522 that generally comprise portions of the driving assembly250 mentioned earlier. Driving tube 520 and driving pin 522 may bealigned with first driven tube 502 and first driven pin 504,respectively. In some embodiments, driving pin 522 may be coaxiallylocated within a hollow longitudinal cavity 526 (see FIG. 35) of drivingtube 520. Driving pin 522 may be capable of translating through hollowlongitudinal cavity 526 of driving tube 520.

In different embodiments, the relative movement of driving tube 520 anddriving pin 522 could vary. In some embodiments, driving tube 520 maymove independently of driving pin 522. In other embodiments, however,driving tube 520 and driving pin 522 may be configured to move together.In one embodiment, driving tube 520 and driving pin 522 may movetogether during some stages of implantation and may move independentlyduring other stages of implantation. For example, during some stages ofimplantation driving pin 522 may remain approximately stationary withrespect to base assembly 210, while driving tube 520 is in motion. As analternative example, during some stages of implantation driving tube 520may remain approximately stationary with respect to base assembly 210,while driving pin 522 is in motion.

Referring now to FIG. 33, base assembly 210 may include provisions thatcontrol the driving motions of driving tube 520 and driving pin 522,including the relative motions between driving tube 520 and driving pin522. These motions are generally initiated and controlled by variousother components including components for storing energy, components forreleasing the stored energy and components for transforming the releasedenergy into a particular sequence of motions accomplished by drivingtube 520 and driving pin 522.

The following discussion describes one possible configuration of baseassembly 210 that may facilitate the actuation of driving tube 520 anddriving pin 522. In some embodiments, some of the following componentsare optional and could be omitted. In other embodiments, additionalcomponents not shown or described here may be added. Moreover, it shouldbe understood that the particular components used to initiate actuation,store energy, and/or control the resulting movement of driving assembly250 could vary in other embodiments.

Base assembly 210 can include provisions for storing energy. In someembodiments, energy could be stored using one or more springs. In oneembodiment, base assembly 210 includes impact spring 550. Generally,impact spring 550 could be any type of spring including, for example, atension spring, a torsion spring, wave spring, and/or a compressionspring. In one embodiment, impact spring 550 is a compression springthat stores mechanical energy.

Impact spring 550 may include first end portion 552 and second endportion 554. In some cases, first end portion 552 may be disposedadjacent to impact collar 556 that generally translates with first endportion 552. In some cases, second end portion 554 may be disposedadjacent to rear bushing 558. As discussed below, the absolute positionsof impact collar 556 and rear bushing 558 within base assembly 210 canbe made to vary.

In some embodiments, impact spring 550 is associated with variousadditional components that facilitate the storage of energy in, and therelease of energy from, impact spring 550. The compression and/orextension of impact spring 550 occurs when the relative distance betweenimpact collar 556 and rear bushing 558, which are generally associatedwith the positions of first end portion 552 and second end portion 554,varies. In some cases, the absolute position of rear bushing 558 withinbase assembly 210 can be controlled using control knob 218 in order toadjust the force. In some cases, for example, a threaded portion 560 ofcontrol knob 218 engages a thread receiving portion 562 of rear bushing558. As control knob 218 is turned, the position of rear bushing 558 canbe moved towards or away from impact collar 556, which adjusts the forcethat is applied to one or more prostheses.

In some embodiments, the absolute position of impact collar 556 maydepend on several components, including positioning ram 570. In somecases, as positioning ram 570 is moved towards rearward portion 211 ofbase assembly 210, impact collar 556 also translates rearwardly. Thiscauses impact spring 550 to compress and store mechanical energy.

In some embodiments, impact collar 556 may be connected to driving tube520. As seen in FIG. 33, driving tube 520 may generally extendrearwardly through base assembly 210 and may terminate within rearwardportion 211. Therefore, as impact collar 556 is translated within baseassembly 210 (for example, by manipulating positioning ram 570 and/orunder the forces of impact spring 550) driving tube 520 may be similarlytranslated with respect to base assembly 210. Furthermore, as describedin detail below, loading impact spring 550 and releasing impact spring550 generates an impacting force at impact collar 556, which istranslated to an impacting force within driving tube 520.

A deployment device can include provisions for retaining an impactspring and associated components of a driving assembly. In someembodiments, a deployment device can be configured with a brace memberthat houses an impact spring as well as a return spring. The bracemember may help to retain the driving assembly relative to a baseassembly. In some embodiments, the brace member may be made of asubstantially rigid material, such as metal, in order to help limitplastic deformation.

FIG. 34 illustrates a schematic isometric view of an embodiment of aportion of deployment device 202. Referring to FIG. 34, brace member1210 comprises a rectangular box-like structure that includes verticalsidewalls and which is substantially open at its upper and lowersurfaces. As seen in FIG. 34, positioning ram 570 is configured to restagainst lower peripheral edge 1212 of brace member 1210. Moreover, bracemember 1210 may be fixed within base assembly 210 through one or morefastening means (not shown).

Referring to FIG. 34, brace member 1210 may include slot 1262 that isdisposed at a forward end of brace member 1210. Slot 1262 may include aperipheral slot portion 1264 and a central hole slot portion 1266. Insome cases, central hole slot portion 1266 has an approximately circularshape and is configured to receive a portion of front bushing 1272. Inaddition, peripheral slot portion 1264 connects central hole slotportion 1266 with lower peripheral edge 1212 and generally has a widththat is substantially less than the diameter of central hole slotportion 1266.

In some embodiments, slot 1262 provides a way of assembling drivingassembly 250 with brace member 1210. In particular, driving tube 520,which extends throughout the length of base assembly 210, may fitthrough peripheral slot portion 1264. Once driving tube 520 is disposedwithin central hole slot portion 1266, front bushing 1272 may be pushedinto place through central hole slot portion 1266. Front bushing 1272may be sized so that it is too large to slide down through peripheralslot portion 1264. Furthermore, the tension provided by impact spring550 (see FIG. 33) and return spring 815 (see FIG. 43) provides arestraining force that prevents front bushing 1272 from backing out ofcentral hole slot portion 1266 and thereby helps retain driving tube 520within brace member 1210.

FIG. 35 illustrates a schematic view of an embodiment of some componentsof driving assembly 250 (see FIG. 33), plurality of driven assemblies260 (see FIG. 32), and prosthesis 270. For purposes of illustrating thegeneral arrangement of these components, the components of drivingassembly 250 and plurality of driven assemblies 260 are shownschematically. For example, the general dimensions of the components,including length and thickness, have been modified to clearly illustratethe relative positions and orientations of the components to oneanother.

Referring to FIG. 35, each of prosthesis 270, first driven tube 502,first driven pin 504, first driving tube 520, and first driving pin 522may be approximately aligned along axis 580. Moreover, the generalarrangement of these components may be such that first driven pin 504 isdisposed coaxially within first driven tube 502 and driving pin 522 isdisposed coaxially within driving tube 520. In particular, first drivenpin 504 may be disposed within hollow longitudinal cavity 510 of firstdriven tube 502. Likewise, driving pin 522 may be disposed within hollowlongitudinal cavity 526 of driving tube 520. This coaxial arrangementfor first driven tube 502 and first driven pin 504 may facilitate thetwo stage implantation process required to properly install prosthesis270 into tissue. Additionally, the coaxial arrangement for driving tube520 and driving pin 522 may ensure that first driven tube 502 and firstdriven pin 504 are properly actuated during the implantation ofprosthesis 270.

In some embodiments, driving assembly 250 and plurality of drivenassemblies 260 may be configured such that driving tube 520 can interactdirectly with first driven tube 502, but not with first driven pin 504.Likewise, in some cases, driving pin 522 may be configured to interactdirectly with first driven pin 504, but not with first driven tube 502.This allows a configuration in which driving tube 520 applies a drivingforce directly to first driven tube 502, while driving pin 522 applies adriving force directly to first driven pin 504. Moreover, it is possiblefor driving tube 520 to pass over first driven pin 504 without affectingthe motion of first driven pin 504. In some embodiments, therefore, thedimensions of first driven pin 504 and driving pin 522 may be selectedso that first driven pin 504 and driving pin 522 have substantiallysimilar diameters. Then, as first driven pin 504 and driving pin 522 arealigned along the same axis 580, driving pin 522 can engage driven pin504 without also engaging first driven tube 502. Likewise, in someembodiments, the dimensions of first driven tube 502 and a portion ofdriving tube 520 may be selected so that first driven tube 502 anddriving tube have substantially similar cross-sectional dimensions. Insome embodiments, driving tube 520 includes a forward portion 517 and arearward portion 519 that have substantially different diameters. In oneembodiment, for example, first driven tube 502 and forward portion 517of driving tube 520 may have substantially similar inner diameters andouter diameters that characterize the corresponding ring-likecross-sectional shapes of both tubes. This allows driving tube 520 toengage first driven tube 502 without also engaging first driven pin 504.

FIGS. 36 through 40 illustrate schematic side views of a method ofimplanting prosthesis 270 into tissue 600 according to one embodiment.For purposes of clarifying the operation of plurality of drivenassemblies 260 (see FIG. 32) and driving assembly 250 (see FIG. 33)during implantation, prosthesis 270, first driven pin 504, first driventube 502, first driving pin 522, and first driving tube 520 are shownhere in isolation, without any other components of deployment device 202(see FIG. 32). Moreover, as discussed above with reference to FIG. 35,these figures are not intended to accurately represent dimensionsincluding, for example, length and width, of the components.

As seen in FIG. 36, as a first step in the process, prosthesis 270 maybe aligned with a desired region of tissue 600. Next, as shown in FIG.37, driving tube 520 and driving pin 522 may apply approximatelyequivalent driving forces to first driven tube 502 and first driven pin504. For purposes of reference the forces applied by driving tube 520are indicated schematically by arrows 491, while forces applied bydriving pin 522 are indicated schematically by arrow 492. These drivingforces are then transferred by first driven pin 504 and first driventube 502 to driving portion 274 and base portion 290, respectively, ofprosthesis 270. During this first stage of the process, prosthesis 270may be driven into tissue 600.

FIGS. 38 and 39 illustrate schematic views of a second stage in theprocess in which the motion of driving pin 522 and first driven pin 504is halted. Driving tube 520, however, continues to move and applies adriving force to first driven tube 502, which is represented by arrows491. This creates an imbalance of forces across prosthesis 270 as baseportion 290 is driven further into tissue 600 while driving portion 274remains in place. Eventually, base portion 290 separates away fromdriving portion 274 and begins to expand under the driving force ofdriving tube 504.

FIG. 40 illustrates a schematic view of prosthesis 270 fully implantedinto tissue 600. At this point, prosthesis 270 may be separated fromfirst driven pin 504 and first driven tube 502. In embodiments where asuture thread is used with prosthesis 270, the suture thread may extendfrom driving portion 274 out through a newly formed opening in tissue600.

As can be seen from comparing the positions of first driven tube 502 andfirst driven pin 504 in FIGS. 36 through 40, first driven tube 502 andfirst driven pin 504 undergo different amounts of displacement duringthe implantation process. For example, referring to FIG. 40, firstdriven tube 502 starts at an initial position 791 prior to implantationand moves to final position 792 once the implantation is complete. Insome cases, final position 792 may be disposed distally farther from adeployment device (not shown) than initial position 791. The distance D3traveled by first driven tube 502 is indicated schematically in FIG. 40.Additionally, first driven pin 504 starts at an initial position 793prior to implantation and moves to final position 794 once theimplantation is complete. In some cases, final position 794 may bedisposed distally farther from the deployment device (not shown) thaninitial position 793. The distance D4 traveled by first driven pin 504is indicated schematically in FIG. 40. In one embodiment, distance D3may be substantially greater than distance D4. In other words, firstdriven tube 502 may travel substantially farther than first driven pin504 during the implantation process.

Similar to the arrangement described above for first driven tube 502 andfirst driven pin 504, driving tube 520 may generally travel farther thandriving pin 522 during implantation. For example, referring to FIG. 40,driving tube 520 starts at an initial position 795 prior to implantationand moves to final position 796 once the implantation is complete. Insome cases, final position 796 may be disposed distally farther from adeployment device (not shown) than initial position 795. The distance D5traveled by driving tube 520 is indicated schematically in FIG. 40.Additionally, driving pin 522 starts at an initial position 797 prior toimplantation and moves to final position 798 once the implantation iscomplete. In some cases, final position 798 may be disposed distallyfarther from the deployment device (not shown) than initial position797. Additionally, in some cases, initial position 797 of driving pin522 may coincide with initial position 795 of driving tube 520. Thedistance D6 traveled by driving pin 522 is indicated schematically inFIG. 40. In one embodiment, distance D5 may be substantially greaterthan distance D6. In other words, driving tube 520 may travelsubstantially farther than driving pin 522 during the implantationprocess.

FIG. 41 illustrates a side cross-sectional view of front deliveryassembly 212 for purposes of describing the geometry of plurality ofdriven assemblies 260. Referring to FIG. 41, some embodiments mayincorporate provisions that help prevent a driven pin from falling outof a driven tube. In some embodiments, a driven pin and driven tube maybe configured with corresponding geometries that help restrict themaximum distance that the driven pin may move within the driven tube. Asone possible example, the current embodiment illustrates first drivenpin 504 having a first portion 1102 and a second portion 1104. In thiscase, first portion 1102 has a substantially smaller diameter thansecond portion 1104. Moreover, hollow longitudinal cavity 510 of firstdriven tube 502 may be configured with a first cavity section 1106 and asecond cavity section 1108. In this case, first cavity section 1106 mayhave a substantially smaller diameter than second cavity section 1108.Moreover, the diameters of first cavity section 1106 and second cavitysection 1108 may be selected so that both first portion 1102 and secondportion 1104 of first driven pin 504 may translate through second cavitysection 1108, but only first portion 1102 may translate through firstcavity section 1106. In particular, first driven pin 504 includesshoulder portion 1110 that may abut an o-ring associated with interiorsurface 1112 of hollow longitudinal cavity 510, which prevents firstdriven pin 504 from translating further in the axial direction. Usingthis arrangement, first driven pin 504 is prevented from falling out offirst driven tube 502, for example, under the force of gravity. It willbe understood that other assemblies of driven assemblies 260 may beconfigured in a similar manner so that each driven pin is prevented fromfalling out of, or over extending from, the corresponding driven tube.

As seen in FIG. 41, some embodiments can further include a ring member1120. Ring member 1120 may be configured to fit around first portion1102 of first driven pin 504 and within second cavity section 1108. Insome cases, ring member 1120 may be configured as a friction ring thathelps to provide a predetermined amount of resistance against therelative movement of first driven pin 504 within first driven tube 502.

FIG. 42 illustrates a schematic cross-sectional view of a portion ofdeployment device 202 in order to illustrate one possible provision forensuring concentric alignment of driving assembly 250 and one or more ofdriven assemblies 260. In one embodiment, each of driving tube 520,driving pin 522, first driven tube 502 and first driven pin 504 may beconfigured with corresponding approximately conical geometries. Forexample, forward end portion 575 of driving tube 520 and forward endportion 577 of driving pin 522 may have concave shapes that receive theconvex shapes of rearward end portion 571 of first driven tube 502 andrearward end portion 573 of first driven pin 504, respectively. Usingthis arrangement, as driving assembly 250 impacts first driven assembly261, these corresponding geometries act to concentrically align firstdriven assembly 261 and driving assembly 250. Of course, it will beunderstood that second driven assembly 262 may be configured with asubstantially similar geometry to first driven assembly 261 so thatsecond driven assembly 262 likewise may have a corresponding geometrywith driving assembly 250 that facilitates concentric alignment.

FIG. 43 illustrates an isometric cut-away view of a portion ofdeployment device 202. For purposes of clarity, only some components ofdeployment device 202 are shown. For example, only some components offront delivery assembly 212 are shown, including first driven tube 502,first driven pin 504 (shown in phantom), and second driven tube 506.

Referring to FIG. 43, driving assembly 250 may comprise variouscomponents that facilitate the two stage implantation process for one ormore prostheses. In some embodiments, driving assembly 250 includesprovisions to control and/or constrain the relative movement betweendriving tube 520 and driving pin 522. In some embodiments, driving tube520 may include longitudinal slot 810. In addition, driving pin 522 mayinclude protruding portion 812 that is perpendicular to the length ofdriving pin 522. In some cases, protruding portion 812 extends throughlongitudinal slot 810. In some cases, protruding portion 812 extendslaterally through longitudinal slot 810. This configuration may limitthe relative movement between driving tube 520 and driving pin 522, aslongitudinal slot 810 constrains the position of protruding portion 812and thereby limits the relative movement of driving pin 522.

In some embodiments, driving assembly 250 includes control hook 802 thatis attached to driving tube 520. In some cases, control hook 802 may beattached to driving tube 520 in a manner that allows control hook 802 topivot about driving tube 520. Moreover, in some embodiments, controlhook 802 may be rotatable between an engaged position and a disengagedposition. As is shown in FIG. 45, in the engaged position, control hook802 may engage protruding portion 812 of driving pin 522. As is shown inFIG. 43, in the disengaged position, control hook 802 may be disengagedfrom protruding portion 812 of driving pin 522. As discussed in furtherdetail below, placing control hook 802 in the engaged position aroundprotruding portion 812 acts to prevent any relative movement betweendriving tube 520 and driving pin 522. Also, with control hook 802 in thedisengaged position, driving pin 522 may move relative to driving tube520.

In some embodiments, driving assembly 250 may further include hookbiasing spring 804. In some embodiments, hook biasing spring 804 may beconfigured to interact with control hook 802. In some cases, thegeometry of hook biasing spring 804 is configured such that control hook802 is rotated into an engaged position when control hook 802 isdisposed beneath hook biasing spring 804.

In some embodiments, driving assembly 250 can include bumper member 814.In some embodiments, bumper member 814 may help to terminate the strokeof impact collar 556 at the end of the impact stroke. Bumper member 814could be configured with any shape, size, and/or material. The shape,size, and material could be selected to absorb a predetermined amount offorce generated by impact collar 556 at the end of the impact stroke.

In some embodiments, driving assembly 250 can also include impact returnspring 815. In some embodiments, impact return spring 815 may bepositioned between impact collar 556 and bumper member 814. In someembodiments, return spring 815 may help bias impact collar 556 in adefault position that is spaced apart from bumper member 814.

Some embodiments can include one or more biasing springs that help biasthe position of driving pin 522 within driving tube 520. For example, asshown in the enlarged cut-away view in FIG. 43, driving assembly 250 mayinclude first biasing spring 820 and second biasing spring 822. In someembodiments, first biasing spring 820 and second biasing spring 822 mayact to bias the position of driving pin 522 within driving tube 520 suchthat the default position of protruding portion 812 is aligned with, andcapable of being engaged by, control hook 810.

As previously discussed, delivery device 202 may include provisions thatallow a surgeon to control the impact force generated by delivery device202. In some embodiments, control knob 218 can be used to adjust theimpact force. In one embodiment, control knob 218 can be used to adjustthe compression of impact spring 550. For example, FIG. 44 illustrates apossible configuration for control knob 218, where control knob 218 hasbeen rotated in a direction represented by arrow 493 in order to adjustthe position of rearward end portion 551 of impact spring 550. In thiscase, rearward end portion 551 may be moved towards forward end portion553 of impact spring 550, which is a direction schematically indicatedby arrow 494, in order to increase the amount that impact spring 550 iscompressed from the free length of impact spring 550. This provides asurgeon with some control of the position of rearward end portion 551,which can be used to adjust the impact force generated duringimplantation. As previously discussed, the position of control knob 218,and thus the amount of impact force generated during implantation, canbe selected according to various factors including the type ofimplantation tissue, the geometry and/or material construction of aprosthesis, the type of tissue repair, and the method of repair employedby the surgeon, as well as other factors.

For purposes of reference, the term “impact cycle” is used throughoutthe remainder of this detailed description and in the figures to referto a sequence of events in which a driving assembly is retracted andthen propelled forward to impact a driven assembly. The impact cycle mayinclude an energy storage stage where the driving assembly is retractedaway from a driven assembly and energy is stored in an energy storagedevice (such as an impact spring). The impact cycle can also include adriving stage where the driving assembly is projected forward to impacta driven assembly as energy is released from the energy storage device.In some cases, the impact cycle starts with the driving assembly in aninitial or pre-actuated position and likewise ends with the drivingassembly in a final position that is substantially the same as theinitial position.

FIGS. 45 through 48 illustrate views of a possible actuating sequencefor driving assembly 250 that allows for the two stage implantationprocess described above and shown schematically in FIGS. 36 through 40.As seen in FIG. 45, positioning ram 570 may be used to adjust theposition of impact collar 556. In some cases, a surgeon may interactwith a trigger or other mechanism in order to move positioning ram 570.

As positioning ram 570 and impact collar 556 are translated rearwardly,impact spring 550 may be compressed, thereby storing mechanical energywithin impact spring 550. Since impact collar 556 is fixedly attached todriving tube 520, control hook 802 may also translate rearwardly untilcontrol hook 802 is disposed beneath hook biasing spring 804. Thiscauses control hook 802 to rotate into a position such that control hookengages protruding portion 812, which is positioned at a distal mostportion of longitudinal slot 810.

Following this, as shown in FIG. 46, positioning ram 570 may rotate outof the way of impact collar 556 as represented by arrow 495, whichallows impact collar 556 to be released. This may occur at the end of atrigger event that includes loading and then releasing impact spring550, or as a separate trigger event that occurs an indefinite period oftime after impact spring 550 has been loaded. Once released, the energystored within impact spring 550 is transferred to impact collar 556 inthe form of mechanical energy. Thus, impact collar 556 may be quicklyaccelerated, which accelerates driving tube 520 and driving pin 522towards driven tube 502 and driven pin 504. With driving tube 520 anddriving pin 522 locked together by control hook 802, driven tube 502 anddriven pin 504 may be impacted simultaneously. This acts to drive acorresponding prosthesis (not shown) into a tissue during the firststage of implantation. As an example, the corresponding motions ofdriving tube 520, driving pin 522, first driven tube 502, and firstdriven pin 504 at this point may be similar to the scenario depicted inFIG. 37.

Referring now to FIG. 47, as driving assembly 250 continues to move inthe forward direction, control hook 802 may disengage with hook biasingspring 804. Moreover, at some point distal end 803 of control hook 802may engage with hook biasing ramp 805 of delivery device 202. Uponengaging with hook biasing ramp 805, control hook 802 may beautomatically rotated from the engaged position to the disengagedposition, which releases protruding portion 812.

Referring now to FIG. 48, with protruding portion 812 released fromcontrol hook 802, driving pin 522 and driving tube 520 may translatewith respect to one another. At this point, driving tube 520 maycontinue to move forward while the motion of driving pin 522 isapproximately stopped or substantially decreased, which starts thesecond stage of the implantation process. In some embodiments, anyfurther motion of driving pin 522 at this point in the impact cycle maybe impeded as protruding portion 812 reaches the end of retaining slot267 (see FIGS. 13 and 14). An example of the corresponding motions ofdriving tube 520, driving pin 522, first driven tube 502, and firstdriven pin 504 at this point may be similar to the scenario depicted inFIGS. 38 and 39. Driving tube 520 may continue to push against driventube 502, while the degree of forces transferred from driving pin 522 todriven pin 520 is drastically reduced. Therefore, driven tube 502continues to deliver an impacting force to a prosthesis while driven pin504 ceases to deliver any substantial impacting force to the prosthesis.This may have the effect of expanding a base portion of a prosthesis (asshow, for example, in FIGS. 38 and 39).

The process described here for applying an impacting force in order toimplant a prosthesis can be repeated. In some cases, this process can berepeated so that multiple impacts are applied to the same prosthesis, asdiscussed in further detail below. In other cases, this process can berepeated by implanting a first prosthesis, rotating front deliveryassembly 212 (see FIG. 54) so as to align a second prosthesis in adriving position, and implanting the second prosthesis. Moreover, forembodiments utilizing N anchors, the process could be repeated at leastN times to implant the N anchors in succession.

A trigger assembly can include provisions for automatically returning toa ready position. In some embodiments, a trigger assembly may beconfigured with provisions to automatically reengage a positioning ramwith an impact collar immediately after actuation of the drivingassembly, once the surgeon has released the trigger portion. Thisconfiguration allows the driving assembly to be conveniently actuatedmultiple times in a given surgical procedure.

FIGS. 49-52 illustrate schematic cut-away views of a portion ofdeployment device 202, in order to demonstrate the detailed operation oftrigger assembly 232 and driving assembly 250. Referring first to FIG.49, trigger assembly 232 comprises trigger portion 216, trigger biasingspring 1200, positioning ram 570 and ram biasing spring 572. Thecomponents of trigger assembly 232 may act to move impact collar 556 ina rearward direction in order to compress impact spring 550.

As previously mentioned, portions of driving assembly 250, includingimpact spring 550 and impact collar 556 are housed within brace member1210. Moreover, positioning ram 570 is biased upwardly by ram biasingspring 572 until it contacts lower peripheral edge 1212 of brace member1210.

In the pre-impact configuration shown in FIG. 49, positioning ram 570 oftrigger assembly 232 is engaged with impact collar 556 of drivingassembly 250. This ensures that as trigger assembly 232 is engaged (forexample, when a surgeon squeezes trigger portion 216) positioning ram570 (which translates with trigger portion 216) will translate impactcollar 556 rearwardly.

Referring next to FIGS. 50 and 51, as trigger portion 216 is squeezed bya surgeon in a direction represented by arrows 496, positioning ram 570is translated along lower peripheral edge 1212 of brace member 1210. Asseen in FIG. 50, positioning ram 570 translates rearwardly in thedirection indicated by arrow 497 and causes impact collar 556 to move ina similar rearward direction indicated by arrow 498, which acts tocompress impact spring 550 and store energy. As positioning ram 570translates down sloped section 1220 of lower peripheral edge 1212,positioning ram 570 is rotated about pivoting portion 1230, asrepresented by arrow 591 (see FIG. 51), until it is below impact collar556. Once positioning ram 570 is rotated out of contact with impactcollar 556, impact spring 550 may rapidly expand. This moves impactcollar 556 in a forward direction represented by arrow 592 in order tosupply an impacting force for driving assembly 250.

Referring next to FIG. 52, following the impacting event, impact collar556 may be moved towards a default position under the force of impactreturn spring 815. In particular, impact collar 556 may travelrearwardly, as represented by arrow 498, towards a default position.Additionally, once trigger portion 216 has been released by the surgeon,trigger biasing spring 1200 biases or urges trigger portion 216 andpositioning ram 570 forwards, as represented by arrows 593 and arrow594. Eventually, following the stage shown in FIG. 52, positioning ram570 is pushed forwards of impact collar 556 and rotated up into anengaged position by ram biasing spring 572. At this point, triggerassembly 232 and driving assembly 250 have been reset so that drivingassembly 250 can be re-engaged when a surgeon depresses trigger portion216 again. In some cases, the final position of deployment devicefollowing a trigger event is substantially identical to the initialconfiguration, which is shown in FIG. 49.

Configuring a deployment device to allow multiple impacts to be appliedto the same prosthesis can improve the versatility of the deploymentdevice. As an example, this configuration may enable a surgeon to adaptto variations in tissue during surgery (e.g. variations in bonedensity). Rather than requiring the deployment device to be tuned sothat the surgeon can be assured the prosthesis will be implanted duringa single impact, the multi-impact design of the embodiments describedhere allow for a surgeon to iteratively implant a prosthesis to thedesired depth through the application of one, two or more impacts to theprosthesis.

Detachable Front Delivery Assembly

FIG. 53 illustrates a cut-away view of adjacent portions of frontdelivery assembly 212 and base assembly 210. In addition to housingportions of plurality of driven assemblies 260 as well as plurality ofprostheses 206 (see FIG. 16), front delivery assembly 212 can alsoinclude various components to facilitate ease of use and further enhancethe functionality of deployment device 202.

With front delivery assembly 212 mounted to base assembly 210, portionsof front delivery assembly 212 may be inserted within forward mountingportion 710. In some cases, a portion of cannula 215 may be insertedinto an interior of forward mounting portion 710. Likewise, in somecases, end portions of first driven pin 504 and first driven tube 502may be disposed within forward mounting portion 710. In a similarmanner, end portions of second driven tube 506 and second driven pin 508could also be disposed within forward mounting portion 710. In addition,first end portion 521 of driving tube 520 and first end portion 523 ofdriving pin 522 may extend through an alignment hole 713 and intoforward mounting portion 710. This arrangement may facilitate thealignment of driving tube 520 and driving pin 522 with first driven tube502 and first driven pin 504, respectively, for example.

As previously mentioned, some embodiments can include provisions forimplanting multiple prostheses in an efficient manner. In some cases,front delivery assembly 212 may include provisions that allow a surgeonto align various components of plurality of driven assemblies 260 withdriving assembly 250. In some cases, for example, front deliveryassembly 212 may include provisions for rotating the positions of somecomponents.

FIG. 54 illustrates an enlarged isometric view of portions of frontdelivery assembly 212, including a rotating assembly 741. Referring toFIG. 54, in some embodiments, rotating assembly 741 could include one ormore components that allow a surgeon to rotate the position of pluralityof driven assemblies 260. For example, while FIG. 53 is shown with firstdriven tube 502 and first drive pin 504 positioned to be aligned withdriving tube 520 and driving pin 522, front delivery assembly 212 may beadjusted so that second driven tube 506 and second driven pin 508 arealigned with driving tube 520 and driving pin 522 as discussed below.This may allow a single driving assembly 250 to apply driving forces toat least two different sets of driven tubes and driven pins disposedwithin front delivery system 210.

As seen in FIG. 54, rotating assembly 741 could be mounted aroundcannula 215. In some embodiments, rotating assembly 741 may be fixedlymounted around cannula 215, so that rotating assembly 741 and cannula215 are configured to rotate together. Moreover, as plurality of drivenassemblies 260 may be fixed in place relative to cannula 215 in someembodiments, plurality of driven assemblies 260 may also be rotatedthrough the use of rotating assembly 741.

In some embodiments, rotating assembly 741 can include rotation controllever 744. In some cases, rotation control lever 744 comprises firstlever portion 746 and second lever portion 748. By grasping first leverportion 746 and/or second lever portion 748, a surgeon can apply torqueto rotating assembly 741, thereby turning rotating assembly 741 andplurality of driven assemblies 260 to a desired position.

Referring now to FIGS. 53 and 54, front delivery assembly 212 mayinclude retracting assembly 760. In some cases, retracting assembly 760may comprise first retracting member 762 and second retracting member764. Each retracting member may include a corresponding retractingslider and driven tube engagement portion. In some cases, firstretracting member 762 includes first slider 766 that extends outwardlyon front delivery assembly 212. First retracting member 762 may alsoinclude first driven tube engaging portion 768. Moreover, first driventube engaging portion 768 may engage first driven tube control post 770,which extends radially from first driven tube 502. First driven tubecontrol post 770 is able to translate within driven tube control slot771. With this configuration, as first driven tube 502 is advancedduring implantation, first driven tube control post 770 may push firstdriven tube engaging portion 768. This acts to advance first slider 766.In some cases, as first driven tube control post 770 contacts a forwardwall of driven tube control slot 771, first driven tube 502 may beprevented from advancing any further. Following implantation ofprosthesis 270 (see FIG. 40), a surgeon may retract first driven tube502 to the pre-implantation position using first slider 766.

Generally, second retracting member 764 may be configured in a similarmanner. In particular, once second driven tube 506 has been aligned withdriving assembly 250 (for example, by rotating second driven tube 506into alignment with driving assembly 250), a second driven tube engagingportion 780 may abut second driven control post 782. As second driventube 506 is advanced during implantation, second driven control post 782slides through driven tube control slot 771. Second driven control post782 further acts to advance second retracting member 764, includingsecond slider 784.

Some embodiments may incorporate provisions that automatically readjustthe positions of one or more prostheses as the plurality of drivenassemblies 260 is rotated. In some cases, for example, the geometry offorward mounting portion 710 of base portion 210 may help control theadvancement and retraction of components of driving assembly 250.

Using this configuration, retracting assembly 760 may serve severalpurposes that facilitate the efficiency of deployment device 202. First,retracting assembly 760 provides a means for retracting a driven tubeand driven pin of plurality of driven assemblies 260 followingimplantation of a prosthesis. In addition, the sliding portions used toretract a driven tube and driven pin may also function as depthindicators that may be used to determine the approximate depth at whicha prosthesis has been implanted.

FIG. 55 illustrates a schematic isometric cross-sectional view of aportion of base assembly 210 and front assembly 212 for purposes ofunderstanding some features of retracting assembly 760 (see FIG. 53). Asseen in FIG. 55, forward edge 1402 of base assembly 210 comprises anapproximately helical geometry that matches the approximately helicalgeometry of interior rearward edge 1404 of front delivery assembly 212.Moreover, front delivery assembly 212 includes an approximately helicalrotational slot 1410 that extends between base assembly 210 and frontdelivery assembly 212. Rotational slot 1410 may be connected with driventube control slot 771, so that a control post translated to rearward end1420 of driven tube control slot 771 may be capable of translatingthrough rotational slot 1410. This configuration helps ensure that frontdelivery assembly 212 may only be rotated when the driven assembly thatis aligned with driving assembly 250 (see FIG. 53) is fully retracted,such that the corresponding control post may then move throughrotational slot 1410. For example, in the configuration shown in FIG.53, driven tube control slot 771 may be used to limit and/or prevent therotation of front delivery assembly 212 until the desired depth isachieved for the current prosthesis, at which time first slider 766 (seeFIG. 53) may be retracted to allow rotation.

As seen clearly in FIG. 55, base assembly 210 includes top attachmentportion 1441 and bottom attachment portion 1443, which may be configuredto facilitate the attachment of front delivery assembly 212 to baseportion 210. Furthermore, FIG. 55 also clearly illustrates alignmentaperture 1439, which may be contoured to help align a driving assembly.In some cases, alignment aperture 1439 has a contoured geometry thatgets narrower in the forwards direction in order to help guide a drivingassembly into proper alignment.

A deployment device can include provisions for ensuring a prosthesis isimplanted to a desired depth within a tissue for a variety of differentconditions. In some embodiments, a deployment device can includeprovisions for re-applying a driving force to a prosthesis. In someembodiments, a driving assembly may be configured to cycle through animpact cycle two or more times in order to implant a prosthesis to adesired depth.

FIGS. 56 through 60 illustrate schematic views intended to depict ascenario in which two impact cycles are required to fully drive aprosthesis into a tissue. For purposes of illustration, tissue 1300 isshown schematically in these figures, though it should be understoodthat tissue 1300 could be any kind of tissue including, for example,skin, bone, muscle, or any other kinds of tissue.

Referring first to FIG. 56, deployment device 202 is in an initial orpre-deployment state. In this state, first prosthesis 270 and firstdriven assembly 261 are aligned with driving assembly 250, but have notbeen engaged by driving assembly 250. In this initial state, firstdriven assembly 261 and driving assembly 250 are separated by a distanceD11. Moreover, in this initial state, first retracting member 762 may bedisposed in a rearward-most position.

Referring next to FIG. 57, as trigger portion 216 is squeezed in adirection represented by arrow 595, driving assembly 250 may proceedthrough an impacting cycle, as described above, which results in animpact between driving assembly 250 and first driven assembly 261. Thisimpact displaces first driven assembly 261 and provides enough force tobegin implanting first prosthesis 270 into tissue 1300. Moreover, aspreviously mentioned, the motion of first driven assembly 261 may causefirst retracting member 762 to similarly move forwards, as representedby arrow 596. As seen in FIG. 58, when the impact cycle has completed,driving assembly 250 may return to a default position. In thisintermediate state of deployment device 202 where driving assembly 250is at rest, driving assembly 250 and first driven assembly 261 may beseparated by a distance D12. Furthermore, first prosthesis 270 has beendriven a distance D14 into tissue 1300. As seen by comparing FIGS. 56and 58, distance D12 is substantially greater than distance D11. Inother words, following the initial impact cycle of driving assembly 250,first driven assembly 261 and driving assembly 250 are spaced fartherapart from one another than the initial spacing.

As seen in FIG. 58, first prosthesis 270 has not been fully implantedinto tissue 1300. This may occur, for example, when tissue 1300 is bonehaving a relatively high density. In this case, the amount of energyrequired to completely implant prosthesis 270 may be greater than theamount of energy supplied by driving assembly 250 during one impactcycle.

To ensure that prosthesis 270 is fully implanted, driving assembly 250may be actuated a second time so that driving assembly 250 undergoes asecond impact cycle during which a second impact between drivingassembly 250 and first driven assembly 261 serves to further driveprosthesis 270 into tissue 1300.

Referring to FIG. 59, driving assembly 250 re-impacts first drivenassembly 261 as a surgeon depresses trigger portion 216 a second time(represented by arrow 595). As previously mentioned, first retractingmember 762 may also translate in a forward direction represented byarrow 596, as first driven assembly 261 is impacted and moves forwards.The result of these two sequential impacts on first driven assembly 261is to fully drive first prosthesis 270 into tissue 1300, as seen in FIG.60. In this final state of deployment device 202 where driving assembly250 is at rest, driving assembly 250 and first driven assembly 261 maybe separated by a distance D13. Furthermore, first prosthesis 270 hasbeen driven a distance D15 into tissue 1300. As seen by comparing FIGS.58 and 60, distance D13 is substantially greater than distance D12. Inother words, the relative spacing between driving assembly 250 and firstdriven assembly 261 increases with each successive impact cycle.Moreover, distance D15 is substantially greater than distance D14 and inparticular, distance D15 may approximately correspond to the desiredimplantation depth of prosthesis 270.

Referring to FIGS. 56 through 60, the depth at which prosthesis 270 hasbeen inserted into a tissue may be obscured by front end portion 1450 offront delivery assembly 212, as well as possibly by features of thesurgical environment (for example, skin, other tissue, etc.). Therefore,in order to determine if prosthesis 270 has been implanted to thedesired depth, a surgeon may make use of first retracting member 762 andin particular the position of first slider 766 to determine the depth ofprosthesis 270. For example, referring to the state of deployment device202 in FIG. 58, a surgeon may see that first slider 766 has not yetreached, or is spaced apart from, its final position adjacent to forwardportion 1460 of retracting assembly 760. At this point, a surgeon maydecide to squeeze trigger portion 216 a second time, thereby actuatingdriving assembly 250 again in order to re-impact first driven assembly261 and thereby drive first prosthesis 270 further into tissue 1300. Inthe final state, shown in FIG. 60, the surgeon may see that first slider766 has reached a final predetermined position that is adjacent toforward portion 1460, which indicates that prosthesis 270 has beenimplanted to the desired depth within tissue 1300.

As seen in FIG. 60, prosthesis 270 (see FIG. 56) may expand at the endof the implantation sequence. As previously described, prosthesis 270may expand when driving tube 520 begins to translate relative to drivingpin 522, which causes first driven tube 502 to translate relative tofirst driven pin 504. Therefore, the expansion of prosthesis 270 may beassociated with a segment of the full range of motion of driving tube520. In this case, the distance traveled by both driving tube 520 andfirst retracting member 762 during the impact cycle may be substantiallygreater than the implantation depth of prosthesis 270.

The current embodiment illustrates an embodiment that requires twoimpact cycles to fully implant prosthesis 270 into tissue 1300. However,it should be understood that the embodiments allow for any number ofimpact cycles to be achieved so that a surgeon can engage triggerassembly 216 as many times as are needed to fully implant a prosthesis.

Using the configuration described here, deployment device 202 may beconfigured so that driving assembly 250 undergoes a full impact cycleeven when a prosthesis is only partially driven into a tissue, as couldoccur if the prosthesis is driven into a high density tissue. In otherwords, driving assembly 250 is configured to undergo substantiallysimilar motions associated with an energy storage stage and a drivingstage each time that trigger portion 216 is engaged by the surgeon andthese motions may be substantially independent of the depth that theprosthesis is driven into a tissue. This helps ensure consistentoperation of deployment device 202 between successive impacts of theprosthesis for a variety of implanting conditions, such as variouspossible densities of the implanting tissue.

FIGS. 61 through 63 illustrate schematic views of the operation of anembodiment of rotating assembly 741 as it facilitates the implantationof multiple prostheses in quick succession. In particular, FIG. 61illustrates a schematic view of an initial position of rotating assembly741 following implantation of a first prosthesis 270. FIG. 62illustrates a schematic view of an intermediate position of rotatingassembly 741 as a second prosthesis is repositioned. FIG. 63 illustratesa schematic view of rotating assembly 741 in a final position in whichsecond prosthesis 272 can be implanted. Although the current embodimentillustrates an example in which two prostheses may be implanted, it willbe understood that other embodiments could incorporate multipleprostheses in a single front delivery assembly. Moreover,straightforward modifications to rotating assembly 741 could be made tohouse and allow for the implantation of three or more prostheses.

Referring first to FIG. 61, first prosthesis 270 has been implanted intotissue 800. At this point, first driven tube 502 is fully advanced. Inorder to implant second prosthesis 272, plurality of driven assemblies260 may be adjusted so that second driven tube 506 and second driven pin508 are aligned with driving tube 520 and driving pin 522. As seen inFIG. 62, this realignment may be accomplished by engaging rotatingassembly 741. In some embodiments, rotation control lever 744 is used torotate driving assembly 260. Using control lever 744, portions of frontdelivery assembly 212 may be rotated in a direction represented byarrows 598 or in a direction opposite of the direction represented byarrows 598. Referring now to FIG. 63, rotating assembly 741 has beenturned approximately 180 degrees from the initial position shown in FIG.61. In this final rotated position, second driven tube 506 and seconddriven pin 508 may be aligned with driving tube 520 and driving pin 522.In this position, second driven tube 506 and second driven pin 508 canbe engaged by driving tube 520 and driving pin 522 in order to implantsecond prosthesis 272 into tissue 800.

Using the arrangement described here, the components of plurality ofdriven assemblies 260 may be associated with at least two differentconfigurations. In a first configuration, shown for example in FIGS. 53and 61, first driven tube 502 and first driven pin 504 may be alignedwith driving tube 520 and driving pin 522, respectively. Also, in thisfirst configuration, first prosthesis 270 may generally be aligned withdriving tube 520 and driving pin 522. In a second configuration, shownfor example in FIG. 63, second driven tube 506 and second driven pin 508may be aligned with driving tube 520 and driving pin 522, respectively.Also, in this second configuration, second prosthesis 272 may generallybe aligned with driving tube 520 and driving pin 522. Moreover, usingrotation control lever 744 (see FIG. 62) allows a surgeon to rotatethese components between the first configuration and the secondconfiguration.

The arrangement described above allows a plurality of prostheses to behoused within front delivery assembly 212. Moreover, each prosthesis maybe disposed in either a driving position, in which the prosthesis isaligned with driving assembly 250 (see FIG. 53), or a storage position,in which the prosthesis is out of alignment with driving assembly 250.Furthermore, in some embodiments, only one prosthesis may be in thedriving position. However, for configurations incorporating three ormore prostheses within front delivery device 212, two or more prosthesescould be in the storage position simultaneously. Thus, front deliveryassembly 212 may provide a prosthesis configured for immediateimplantation, and may also provide storage for one or more prostheses.

As seen in FIGS. 61 through 63, the process of adjusting secondprosthesis 272 from the storage position to the driving positionincludes rotating front delivery assembly 212 about its own centrallongitudinal axis 599. Moreover, front delivery assembly 212 is rotatedwith respect to base assembly 210, which stays in place within thesurgeon's hand as the position of second prosthesis 272 is adjusted.Thus, the driving position and the storage position may be characterizedas angularly displaced from one another with respect to centrallongitudinal axis 599 of front delivery assembly 212.

As seen in the enlarged cut-away views included in FIGS. 61 through 63,first prosthesis 270 and second prosthesis 272 may be connected bysuture thread 830. Following the insertion of first prosthesis 270,suture thread 830 may remain taut against a side of first prosthesis 270and may extend back to second prosthesis 272, which is still housedwithin cannula 215 at this stage. Once second prosthesis 272 isimplanted within tissue 800, as seen in FIG. 63, suture thread 830 maybe pulled taut along the surface of tissue 830, anchored in place byfirst prosthesis 270 and second prosthesis 272.

FIGS. 61 through 63 further illustrate indentation 989 of rotatingassembly 741. In some embodiments, indentation 989 may be configured toreceive first flange portion 991 or second flange portion 993. As frontdelivery assembly 212 is rotated, first flange portion 991 and secondflange portion 993 may rotate, while indentation 989 is fixed in place.Moreover, indentation 989 may be positioned such that first flangeportion 991 or second flange portion 993 is received in indentation 989when either of driven assemblies 260 are aligned with driving tube 520and driving pin 522. First flange portion 991 and second flange portion993 may engage indentation 989 in a manner that helps to resistaccidental rotation of front delivery assembly 212. Although only oneindentation is visible in FIGS. 61 through 63, it should be understoodthat some embodiments can include at least two correspondingindentations, such as having a pair of indentations disposed 180 degreesapart from one another about central longitudinal axis 599 that bothreceive either first flange portion 991 or second flange portion 993.

FIGS. 64 and 65 illustrate schematic cut-away views of a portion offront delivery assembly 212 for the purposes of showing the relationshipof various components of front delivery assembly 212. The specific viewsshown in FIGS. 64 and 65 illustrate a region where driving tube 520enters front delivery assembly 212. Moreover, the cut-away view seen inFIGS. 64 and 65 is taken such that a top half of front delivery assembly212 (specifically, the top half of cannula 215 that is shown in FIG. 53)has been removed forwards of a locking member 871. Locking member 871 isdescribed in detail below, and in some embodiments it may generally forma rearward end of cannula 215.

Referring to FIGS. 64 and 65, some embodiments can include provisions tohelp prevent unintentional actuation of a deployment device. In someembodiments, front delivery assembly 212 may include locking member 871.Locking member 871 may comprise a ring-like member including an inneredge 873 that defines an inner diameter for locking member 871. In somecases, inner edge 873 is designed to engage locking groove 875 ofdriving tube 520. Moreover, locking member 871 may include first gap 877and second gap 879. When either first gap 877 or second gap 879 aredisposed directly over driving tube 520, driving tube 520 is free totranslate axially. However, should locking member 871 be rotated to anyother angular position (for example, any angular position where firstdriven tube 502 or second driven tube 506 are out of alignment withdriving tube 520), inner edge 873 engages locking groove 875 andprevents axial movement of driving tube 520. For example, FIG. 65illustrates a configuration where front delivery assembly 212 has beenrotated in a direction represented by arrows 597 so that inner edge 873is engaged with locking groove 875. This state may be described as alocked-out state, in which driving tube 520 is locked and unable totranslate. This is in contrast to the ready to actuate state of FIG. 64,where driving tube 520 is free to translate and impact a driven tube.This arrangement may help ensure that driving tube 520 is notaccidentally actuated while front delivery assembly 212 is disposed inan intermediate position where neither of the two driving assemblies areproperly aligned with driving tube 520.

FIG. 66 illustrates another cut-away view of portions of front deliveryassembly and base portion 210. Referring to FIG. 66, in someembodiments, front delivery assembly 212 may be mounted to forwardportion 209 of base assembly 210, rather than being integrally formedwith base assembly 210. In order to receive front delivery assembly 212,in some cases base assembly 210 can include forward mounting portion710. In some embodiments, forward mounting portion 710 may be atube-like portion. Additionally, forward mounting portion 710 mayinclude upper mounting shoulder 712 and lower mounting shoulder 714. Insome cases, upper mounting shoulder 712 and lower mounting shoulder 714may be formed by varying the radial thickness of forward mountingportion 710. Also, the end surfaces between forward mounting portion 710and second mounting portion 724 of mounting assembly 720 are contouredto facilitate the axial movement of the driven assemblies 260 from thestorage position to the deployed position.

In some embodiments, front delivery assembly 212 may include mountingassembly 720 that includes provisions for mounting front deliveryassembly 212 to base assembly 210 at forward mounting portion 710. Insome cases, mounting assembly 720 may further include first mountingportion 722 and second mounting portion 724 (also shown in FIG. 67). Insome cases, first mounting portion 722 may be sized and shaped to slideover an exterior surface of forward mounting portion 710. In addition,second mounting portion 724 may include one or more fastening portions.In one embodiment, second mounting portion 724 may include firstfastening portion 730 and second fastening portion 732. In some cases,first fastening portion 730 and second fastening portion 732 may beconfigured to engage upper mounting shoulder 712 or lower mountingshoulder 714, respectively. In some cases, first fastening portion 730and second fastening portion 732 comprise snap hooks that rest againstupper mounting shoulder 712 and lower mounting shoulder 714,respectively. This configuration helps to prevent front deliveryassembly 212 from disengaging with base assembly 210 during use.

Some embodiments may include provisions to facilitate easy detachment offront delivery assembly 212 from base assembly 210. In some embodiments,mounting assembly 720 may include a release mechanism. In someembodiments, second mounting portion 724 may include one or more releaselevers. In one embodiment, second mounting portion 724 includes firstrelease lever 740 that is associated with first fastening portion 730.Additionally, second mounting portion 724 may include second releaselever 742 that is associated with second fastening portion 732. Asdescribed in further detail below, first release lever 740 and secondrelease lever 742 may be depressed by a surgeon in order to disengagefirst fastening portion 730 and second fastening portion 732,respectively, from forward mounting portion 710 of base portion 210.

The particular features described here for detachably mounting frontdelivery assembly 212 with base assembly 210 are intended to beexemplary. It should therefore be understood that other embodiments ofdeployment device 202 can include any other means for detachablymounting front delivery assembly 212 with base assembly 210. Otherembodiments could utilize one or more removable fasteners that help todetachably mount front delivery assembly 212 with base assembly 210. Inone alternative embodiment, for example, front delivery assembly 212 andbase assembly 210 could comprise corresponding threading and threadreceiving portions that would provide for front delivery assembly 212 tobe screwed onto base assembly 210.

FIGS. 67 through 69 illustrate isometric views of a process of detachingfront delivery assembly 212 from base assembly 210, according to oneembodiment. In order to detach front delivery assembly 212 a surgeon maydepress first release lever 740 and second release lever 742, asrepresented by arrows 697 in FIGS. 67 and 68. As seen in FIG. 68, asfirst release lever 740 and second release lever 742 are depressed,first fastening portion 730 and second fastening portion 732 may bereleased from engagement with upper mounting shoulder 712 and lowermounting shoulder 714, respectively, which is represented schematicallyby arrows 698. At this point, a surgeon is able to pull mountingassembly 720 off of forward mounting portion 710, thereby separatingfront delivery assembly 212 and base assembly 210, as shown in FIG. 69.Here, the motion of front delivery assembly 212 away from base assembly210 is represented by arrows 699. Of course, a similar process inreverse order (not shown) could be used to attach front deliveryassembly 212 and base assembly 210.

The embodiments described above allow for a detachable front deliveryassembly 212 to be used with base assembly 210. To enhance the ease ofuse, some embodiments may include provisions for associating multipledifferent front delivery systems with a single base assembly. Inparticular, some embodiments may make use of multiple front deliveryassemblies that may be disposed of after use. This may improve ease ofuse by removing potentially cumbersome steps of replacing individualprostheses and/or driven assemblies within a front delivery assembly.

Some of the components described above for a front delivery assemblycould be optional. In some embodiments, for example, one or more drivenassemblies could be optional. In one such alternative embodiment, adetachable front delivery assembly may be configured to house one ormore prostheses but may not include any driven assemblies. In such anembodiment it is contemplated that the prostheses of the front deliveryassembly may be directly associated with a driving assembly of adeployment device. For example, one such embodiment of a front deliveryassembly could include an arrangement such that first prosthesis 270 andsecond prosthesis 272 may be directly aligned with, and configured to bedirectly driven by, driving assembly 250 of base assembly 210 (see FIGS.15 and 16). In such an embodiment, the front delivery assembly could besignificantly shorter than front delivery assembly 212 described above,to ensure that first prosthesis 270 and second prosthesis 272 arecapable of direct contact with driving assembly 250. Furthermore, itwill be understood that such alternative embodiments could incorporateadditional changes to accommodate other constraints imposed by theremoval of one or more driven assemblies. For example, in thealternative embodiment described here, the step or steps of associatingfirst prosthesis 270 or second prosthesis 272 with driving assembly 250may further include a step of inserting driving pin 522 into acorresponding longitudinal cavity of first prosthesis 270 or secondprosthesis 272 prior to implantation. This additional step may helpensure that driving tube 520 and driving pin 522 provide the desiredimpacting forces on a driving portion and a base portion, respectively,of a prosthesis during the first stage of implantation.

FIG. 70 illustrates a schematic view of an exemplary embodiment of kitof parts 850 that comprises various interchangeable front deliveryassemblies for use with a single base assembly 210. Referring to FIG.70, kit of parts 850 may include first front delivery assembly 852,second front delivery assembly 854, and third front delivery assembly856. Each assembly could be interchangeably used with base assembly 210.

In some embodiments, each of first front delivery assembly 852, secondfront delivery assembly 854 and third front delivery assembly 856 may besubstantially identical. For example, each of first front deliveryassembly 852, second front delivery assembly 854, and third frontdelivery assembly 856 could incorporate similar components including thesame number of prostheses for implantation. In other embodiments,however, two or more of first front delivery assembly 852, second frontdelivery assembly 854, and third front delivery assembly 856 coulddiffer in some aspect including the number of prostheses. For example,one kit could include a front delivery assembly including twoprostheses, another front delivery assembly including three prostheses,and still another front delivery assembly including four prostheses.

The kit of parts 850 described here may allow for more flexibility inrepairing various forms of tissue imperfections during surgery.Different sterile and prepackaged front delivery assemblies could varyin provisions, including, but not limited to, suture types, suturelengths, anchor types, anchor sizes, anchor materials, anchor number,cannula size, cannula depth, as well as other features. During surgery,a surgeon may select the most desirable front delivery assembly based onconditions encountered during surgery, rather than relying on a singleconfiguration for a deployment device that is determined using onlypre-surgical information. For example, this may allow a surgeon toincrease the number of available prostheses for repairing animperfection based on surgery conditions. Likewise, this may allow asurgeon to change the type or material of prostheses to be used in arepair based on surgery conditions. In each case, a surgeon can simplyinterchange the currently attached front delivery assembly with a moresuitable front delivery assembly according to surgery conditions.

It is contemplated that a method of providing a deployment device tocustomers could incorporate providing a kit of parts including a singlebase assembly as well as two or more front delivery assemblies. In termsof retail considerations, in some cases, an intended surgeon couldpurchase a kit including the base assembly as well as multiple frontdelivery assemblies. In other cases, some components could be soldseparately while still being intended for use together.

A detachable front assembly can include provisions to hold tissue inplace prior to implanting one or more prostheses. In some embodiments,for example, a detachable front assembly can include one or more holdingmembers. In some embodiments, a holding member could comprise a pin-likeprojection that acts to position and/or hold down a tendon and/or muscleover a particular location of a bone. In one embodiment, a holdingmember could be used to position and/or hold down a portion of a rotatorcuff tendon that is being positioned for reattachment to an underlyingbone.

FIGS. 71 and 72 illustrate schematic views of an embodiment of adetachable front system 900 that includes plurality of holding members902. In some embodiments, plurality of holding members 902 may comprisefour individual holding members including first holding member 911,second holding member 912, third holding member 913, and fourth holdingmember 914. Each of first holding member 911, second holding member 912,third holding member 913, and fourth holding member 914 may be shapedand aligned in a manner that facilitates holding down a tendon or othertype of tissue in place over a bone. Moreover, each of first holdingmember 911, second holding member 912, third holding member 913, andfourth holding member 914 may extend outwardly from forward rim 901 ofdetachable front delivery system 900.

As seen in FIG. 72, plurality of holding members 902 may be used to pindown portion 920 tendon 922 in a predetermined location of bone 924. Asportion 920 may be a portion that of tendon 922 that requiresreattachment, plurality of holding members 902 may act to keep portion920 in place and thereby prevent the natural contraction or recession ofportion 920 away from the desired location on bone 924. With thisarrangement, a surgeon may operate a delivery device to deploy one ormore prostheses through tendon 922 and bone 924 without requiring thesurgeon to manipulate the position of portion 920 through an additionaltool or means. This may simplify the implantation procedure.

Generally, the number of holding members used with a delivery devicecould vary in different embodiments. In some cases, a single holdingmember could be used. In other cases, two or more holding members couldbe used. In still other cases, three holding members could be used. Instill other cases, four holding members could be used. In still othercases, five or more holding members could be used.

The alignment of two or more holding members could vary in differentembodiments. Some embodiments could utilize holding members that areapproximately evenly spaced around a distal end of detachable frontdelivery system 900. In other embodiments, the spacing or configurationof holding members could vary and could include asymmetricconfigurations or configurations with uneven spacing.

The geometry of each holding member could vary in different embodiments.In some embodiments, each holding member could have a substantiallysimilar geometry. In other embodiments, the geometry of at least twoholding members could be substantially different. For example, someembodiments could incorporate two or more holding members of differentlengths (as measured from the distal end of a delivery device).

Some embodiments may include provisions for retracting one or moreholding members. Some embodiments could include holding members that areattached to a moveable tube, cannula, or other similar component that isdisposed within a detachable front delivery system. As one example,shown in FIG. 73, detachable front delivery system 1000 includes anouter cannula 1002 and an inner cannula 1004. Plurality of holdingmembers 1006 may be attached to, and/or formed with, inner cannula 1004.This configuration may allow for holding members 1006 to be protectedwithin movable outer cannula 1002, which is spring loaded via spring1020. This may help prevent plurality of holding members from engagingtissue until the surgeon has located outer cannula 1002 at the desiredlocation for implantation.

Whatever its ultimate use or features, a deployment device as discussedhere (for example, deployment device 202 of FIG. 13) may be adapted foruse in a medical environment. For example, some components of deploymentdevice 202 could be detachable from their respective points ofconnection on base assembly 210 and/or front delivery assembly 212, soas to facilitate autoclaving or other sterilization procedures. In someembodiments, base assembly 210 itself may also be autoclavable orotherwise sterilizable. As previously mentioned, a front deliveryassembly could be packaged sterile and/or disposable. In someembodiments, the entire deployment device could be packaged sterileand/or disposable.

Further, in describing representative embodiments of the presentinvention, the specification may have presented the method and/orprocess of the present invention as a particular sequence of steps.However, to the extent that the method or process does not rely on theparticular order of steps set forth herein, the method or process shouldnot be limited to the particular sequence of steps described. As one ofordinary skill in the art would appreciate, other sequences of steps maybe possible. Therefore, the particular order of the steps set forth inthe specification should not be construed as limitations on the claims.In addition, the claims directed to the method and/or process of thepresent invention should not be limited to the performance of theirsteps in the order written, and one skilled in the art can readilyappreciate that the sequences may be varied and still remain within thespirit and scope of the present invention.

While various embodiments have been described, the description isintended to be exemplary, rather than limiting and it will be apparentto those of ordinary skill in the art that many more embodiments andimplementations are possible that are within the scope of theembodiments. Accordingly, the embodiments are not to be restrictedexcept in light of the attached claims and their equivalents. Also,various modifications and changes may be made within the scope of theattached claims.

What is claimed is:
 1. A deployment device for repairing tissue,comprising: a front delivery assembly including a driven assemblyconfigured to hold a prosthesis; a base assembly comprising a drivingassembly that is configured to impact the driven assembly; a triggerassembly for activating the driving assembly; wherein the deploymentdevice is configured such that the driving assembly is adapted to impactthe driven assembly multiple times by engaging the trigger assemblymultiple times; and wherein subsequent impacts of the driving assemblywith the driven assembly are configured to drive the prosthesis fartherinto the tissue.
 2. The deployment device according to claim 1, whereinthe driving assembly is powered by an impact spring.
 3. The deploymentdevice according to claim 2, wherein the impact spring is compressed andreleased using the trigger assembly.
 4. The deployment device accordingto claim 1, wherein the driving assembly undergoes an impact cycle thatincludes an energy storage stage and a driving stage.
 5. The deploymentdevice according to claim 4, wherein driving assembly returns to asubstantially similar position between impact cycles.
 6. The deploymentdevice according to claim 1, wherein the front delivery assemblyincludes a depth indicator that can be used to determine if theprosthesis has been fully implanted into the tissue.
 7. A deploymentdevice, comprising: a front delivery assembly including a drivenassembly configured to hold a prosthesis; a base assembly comprising adriving assembly; a trigger assembly for activating the drivingassembly; wherein the deployment device is operable in: an initial statein which the driving assembly is at rest and the driving assembly andthe driven assembly are spaced apart by a first distance; anintermediate state in which the driving assembly is at rest and thedriving assembly and the driven assembly are spaced apart by a seconddistance; a final state in which the driving assembly is at rest and thedriving assembly and the driven assembly are spaced apart by a thirddistance; and wherein the third distance is greater than the seconddistance and wherein the second distance is greater than the firstdistance.
 8. The deployment device according to claim 7, wherein theposition of the driving assembly is approximately the same in theinitial state, the intermediate state and a final state.
 9. Thedeployment device according to claim 7, wherein the position of thedriven assembly within the front delivery assembly is advanced from theinitial state to the intermediate state.
 10. The deployment deviceaccording to claim 9, wherein the position of the driven assembly withinthe front delivery assembly is advanced from the intermediate state tothe final state.
 11. The deployment device according to claim 7, whereinthe driven assembly is impacted by the driving assembly in between theinitial state and the intermediate state and wherein the driven assemblyis impacted by the driving assembly in between the intermediate stateand the final state.
 12. The deployment device according to claim 7,wherein the front delivery assembly has a first rotational position inwhich the driven assembly is aligned with the driving assembly and asecond rotational position in which the driven assembly is out ofalignment with the driving assembly.
 13. The deployment device accordingto claim 12, wherein the front delivery assembly can be placed in alocked out state and a ready to actuate state and wherein movement ofthe driving assembly is prevented when the front delivery assembly is inthe locked out state and wherein movement of the driving assembly isallowed when the front delivery assembly is in the ready to actuatestate.
 14. A method of implanting a prosthesis into tissue using adeployment device, comprising: actuating a driving assembly so that thedriving assembly engages a driven assembly corresponding to theprosthesis; observing a position of a depth indicator that is associatedwith a depth to which the prosthesis has been implanted within thetissue; and actuating the driving assembly a second time if the positionof the depth indicator is spaced apart from a predetermined depthposition.
 15. The method according to claim 14, wherein actuating thedriving assembly includes engaging a trigger portion of the deploymentdevice.
 16. The method according to claim 14, using the depth indicatorto retract the driven assembly after the driven assembly has beenengaged by the driving assembly.
 17. The method according to claim 14,wherein actuating the driving device a second time is followed byobserving a second position of the depth indicator.
 18. The methodaccording to claim 17, wherein observing the second position of thedepth indicator is followed by actuating the driving assembly a thirdtime if the second position of the depth indicator is spaced apart fromthe predetermined depth position.
 19. The method according to claim 14,further comprising retracting the driven assembly when the prosthesishas been fully implanted.
 20. The method according to claim 19, whereinretracting the driven assembly is accomplished by retracting the depthindicator.